1770539355 NPI number — DR. BARRY MICHAEL NEMROW DPM

Table of content: JAHANGIR AKHTAR (NPI 1043751373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770539355 NPI number — DR. BARRY MICHAEL NEMROW DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEMROW
Provider First Name:
BARRY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1770539355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 GRANT AVE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94945-3157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-897-7187
Provider Business Mailing Address Fax Number:
415-897-7938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 GRANT AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
NOVATO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94945-3157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-897-7187
Provider Business Practice Location Address Fax Number:
415-897-7938
Provider Enumeration Date:
05/26/2006

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: 213ES0131X , with the licence number:  E2585 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 480025698 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: NE1200 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0270980001 . This is a "MEDICARE CIGNA NOW NOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 000E25851 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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