Individual
CHANNEL ANTIONETTE BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2888 FABER TER # 2, FAR ROCKAWAY, NY 11691-1706
(516) 690-7836
Mailing address
2888 FABER TER # 2, FAR ROCKAWAY, NY 11691-1706
(516) 690-7836
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
339705-01
NY
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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