MEDICARE: ANTOINETTE MARIE BERRY NDTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian	1000095	NJ

General Provider Information

NPI Number	:	1841141892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE MARIE BERRY NDTR

Provider Business Mailing Address
First Line	:	1614 BOSTON AVE
Second Line	:
City	:	WILLIAMSTOWN
State	:	NJ
Zip	:	08094-3405
Country	:	US
Telephone Number	:	609-560-5616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1614 BOSTON AVE
Second Line	:
City	:	WILLIAMSTOWN
State	:	NJ
Zip	:	08094-3405
Country	:	US
Telephone Number	:	609-560-5616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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