Healthcare Provider Details

I. General information

NPI: 1083823454
Provider Name (Legal Business Name): TYMARA B BERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-4340
  • Fax: 73-290-7367
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number25MA08636700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number236197
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: