Healthcare Provider Details

I. General information

NPI: 1508106147
Provider Name (Legal Business Name): MARIA C. BERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RIVERSIDE DRIVE LOURDES HOSPTIAL
BINGHAMTON NY
13905-4198
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 607-798-5231
  • Fax:
Mailing address:
  • Phone: 856-686-4317
  • Fax: 856-848-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337710
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: