MEDICARE: LOVERNA ABELLA BERO PT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	041228-1	NY
2	225100000X	Physical Therapist	40QA01739800	NJ

General Provider Information

NPI Number	:	1023557394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOVERNA ABELLA BERO PT DPT

Provider Business Mailing Address
First Line	:	718 23RD ST APT 1
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-9133
Country	:	US
Telephone Number	:	862-228-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 HARRISTOWN RD STE 304
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3321
Country	:	US
Telephone Number	:	862-228-4636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2017
Last Update Date	:	01/30/2024

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