1215993605 NPI number — MR. JONATHAN ALEXANDER BARBER SR. FNP-BC

Table of content: MR. JONATHAN ALEXANDER BARBER SR. FNP-BC (NPI 1215993605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215993605 NPI number — MR. JONATHAN ALEXANDER BARBER SR. FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBER
Provider First Name:
JONATHAN
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
FNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215993605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 MIX PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATAVIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14020-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-230-4579
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKFIELD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14125-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-948-8077
Provider Business Practice Location Address Fax Number:
585-948-9159
Provider Enumeration Date:
04/25/2006

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: 363LF0000X , with the licence number:  F3343401 , 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: 9512796 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P019334340 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00027001201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000560919001 . This is a "BCBS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 156044BF . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02624073 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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