Healthcare Provider Details

I. General information

NPI: 1457579252
Provider Name (Legal Business Name): DEANENE V BERRY AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEANENE V BERRY AU.D

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/26/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ STE 630
HACKENSACK NJ
07601-6210
US

IV. Provider business mailing address

2 UNIVERSITY PLZ STE 226
HACKENSACK NJ
07601-6210
US

V. Phone/Fax

Practice location:
  • Phone: 201-645-5440
  • Fax: 201-645-5443
Mailing address:
  • Phone: 201-645-5440
  • Fax: 201-645-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006035
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000631
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number00631
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number25MG00109400
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00072700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: