1457465080 NPI number — DR. KENNETH D BAROFSKY M.D., F.C.C.P.

Table of content: DR. KENNETH D BAROFSKY M.D., F.C.C.P. (NPI 1457465080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457465080 NPI number — DR. KENNETH D BAROFSKY M.D., F.C.C.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAROFSKY
Provider First Name:
KENNETH
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., F.C.C.P.
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:
1457465080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 160, CN 5050
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-2537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-577-0600
Provider Business Mailing Address Fax Number:
732-577-6332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 160, CN 5050
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-577-0600
Provider Business Practice Location Address Fax Number:
732-577-6332
Provider Enumeration Date:
08/19/2006

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: 207RP1001X , with the licence number:  25MA05526000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 223019073 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223019073-004 . This is a "QUALCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3000228 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7V831 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P401087 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K2127 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00020224 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223019073-004 . This is a "ST BARNABAS HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5504503 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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