Healthcare Provider Details

I. General information

NPI: 1700423142
Provider Name (Legal Business Name): BETH TANSEY PELLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RAMAPO VALLEY RD # LL104
OAKLAND NJ
07436-2509
US

IV. Provider business mailing address

169 RAMAPO VALLEY RD # LL104
OAKLAND NJ
07436-2509
US

V. Phone/Fax

Practice location:
  • Phone: 201-368-3800
  • Fax:
Mailing address:
  • Phone: 201-368-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number26NO07492000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number26NO07492000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: