1730325721 NPI number — DR. THELMA BARKER GAETANO M.D.

Table of content: DR. THELMA BARKER GAETANO M.D. (NPI 1730325721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730325721 NPI number — DR. THELMA BARKER GAETANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAETANO
Provider First Name:
THELMA
Provider Middle Name:
BARKER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAETANO
Provider Other First Name:
THEMELINA
Provider Other Middle Name:
BARKER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730325721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 COMMACK RD UNIT 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11725-5022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-675-2125
Provider Business Mailing Address Fax Number:
631-675-2628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 MEETING HOUSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAMPTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11968-5087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-283-7733
Provider Business Practice Location Address Fax Number:
631-283-3183
Provider Enumeration Date:
12/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  35.088709 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 307332 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3153555 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".