Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X005933-1 | NY |
N | 111NS0005X | Chiropractic Sports Physician | X005933-1 | NY |
NPI | 1295058170 |
---|---|
Provider Name | Dr. Thomas G. Barba |
First Address | Lewiston, NY 14092-1205 |
Second Address | Lewiston, NY 14092-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2010 |
Last Update Date | 08/03/2010 |