Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 16691 | MD |
Y | 1223E0200X | Endodontist | DS042240 | PA |
NPI | 1043620701 |
---|---|
Provider Name | Dr. Yaakov R Barak |
First Address | Baltimore, MD 21209-2604 |
Second Address | Hanover, PA 17331-1866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2014 |
Last Update Date | 10/12/2019 |