Healthcare Provider Details

I. General information

NPI: 1922922178
Provider Name (Legal Business Name): BETHANY CHERYL MITROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SUMMIT AVE
SUMMIT NJ
07901-2813
US

IV. Provider business mailing address

41 COLFAX DR
PEQUANNOCK NJ
07440-1015
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-0228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTL-5158
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: