Provider Demographics
NPI:1902124357
Name:MARCIAL-BERRIOS, MARIA (LPN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MARCIAL-BERRIOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 CLIFTON DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1979
Mailing Address - Country:US
Mailing Address - Phone:856-813-0705
Mailing Address - Fax:
Practice Address - Street 1:905 CLIFTON DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1979
Practice Address - Country:US
Practice Address - Phone:856-813-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06234500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse