Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 165292 | NY |
NPI | 1003994260 |
---|---|
Provider Name | Jay M Barbakoff |
First Address | Port Jefferson, NY 11777 |
Second Address | Port Jefferson, NY 11777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 18/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011228990 | (05) | NY |
22F45EC831 | MEDICARE OTHER PIN (01) | NY |
E17231 | (02) |