Provider Demographics
NPI:1972875862
Name:BERRY, MARGARET DEVON (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:DEVON
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 PIERPONT ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3143
Mailing Address - Country:US
Mailing Address - Phone:201-704-8706
Mailing Address - Fax:
Practice Address - Street 1:2350 N 3RD ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5049
Practice Address - Country:US
Practice Address - Phone:908-851-6548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001411002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer