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General NPI Number Information
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NPI Number | 1043782915
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Entity Type | Individual
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Provider Name | BETH NICOLE PERGAMENT MSED
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 3200 WATERBURY DR
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City | WANTAGH
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State | NY
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Zip | 11793-3332
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Country | US
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Telephone | 516-761-4756
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 WATERBURY DR
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City | WANTAGH
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State | NY
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Zip | 11793-3332
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Country | US
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Telephone | 516-761-4756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2171709
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License Number State | NY
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