Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 207QA0401X | Family Doctor - Addiction Medicine | 307677 | NY |
Y | 208D00000X | General Practice Physician | 307677 | NY |
NPI | 1750743092 |
---|---|
Provider Name | Jessica Barenboim |
First Address | Hudson, NY 12534 |
Second Address | Hudson, NY 12534-2447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 20/08/2021 |