Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X004084-1 | NY |
NPI | 1508004805 |
---|---|
Provider Name | Brian Michael Barrett |
First Address | Southampton, NY 11968-2006 |
Second Address | Southampton, NY 11968-2006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2009 |
Last Update Date | 26/01/2009 |