Provider Demographics
NPI:1841958436
Name:BERRY, JUSTIN (RN)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MOUNT RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4826
Mailing Address - Country:US
Mailing Address - Phone:585-451-0364
Mailing Address - Fax:
Practice Address - Street 1:38 MOUNT RIDGE CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4826
Practice Address - Country:US
Practice Address - Phone:585-451-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse