Healthcare Provider Details

I. General information

NPI: 1285565994
Provider Name (Legal Business Name): BEROTHY ST. JOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 WITHERSPOON ST STE 201
PRINCETON NJ
08540-3328
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5012
US

V. Phone/Fax

Practice location:
  • Phone: 609-622-5624
  • Fax:
Mailing address:
  • Phone: 631-359-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB0042980
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: