Provider Demographics
NPI:1659118370
Name:NEWBERRY, BOOKER IV
Entity type:Individual
Prefix:MR
First Name:BOOKER
Middle Name:
Last Name:NEWBERRY
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1377
Mailing Address - Country:US
Mailing Address - Phone:330-774-5679
Mailing Address - Fax:
Practice Address - Street 1:1875 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1377
Practice Address - Country:US
Practice Address - Phone:330-774-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide