Individual
MARY M BARBARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
61 DELANO ST, PULASKI, NY 13142-1400
(315) 298-6564
(315) 298-7488
Mailing address
61 DELANO ST, PULASKI, NY 13142-1400
(315) 298-6564
(315) 298-7488
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
011647
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00307662
—
NY
01
—
331880
FQHC NUMBER
—
05
—
PENDING
—
NY
Enumeration date
12/01/2006
Last updated
07/09/2007
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