1275602583 NPI number — BRIAN D BARABAN

Table of content: BRIAN D BARABAN (NPI 1275602583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275602583 NPI number — BRIAN D BARABAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARABAN
Provider First Name:
BRIAN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1275602583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 MIDDLE COUNTRY RD
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
SELDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11784-2554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-698-2267
Provider Business Mailing Address Fax Number:
631-698-2232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 MIDDLE COUNTRY RD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
SELDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11784-2554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-698-2267
Provider Business Practice Location Address Fax Number:
631-698-2232
Provider Enumeration Date:
11/08/2006

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: 213E00000X , with the licence number:  N002270 , 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: 0057872 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: PJ5481 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480529 . This is a "UNITED HEALTHCARE COMMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10231 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00414411 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3C6645 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5253490001 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P490336 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: P022708 . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070016923 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100048052901 . This is a "UNITED HEALTHCARE GOVERNM" identifier . This identifiers is of the category "OTHER".




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