MEDICARE: DR. KAMI QUINN BARRY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	222984	NY

General Provider Information

NPI Number	:	1114936317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMI QUINN BARRY D.O.

Provider Business Mailing Address
First Line	:	76 SOUTHAVEN AVE
Second Line	:	SUITE 4
City	:	MEDFORD
State	:	NY
Zip	:	11763-3745
Country	:	US
Telephone Number	:	631-569-4055
Fax Number	:	631-569-4056

Provider Business Practice Location Address
First Line	:	76 SOUTHAVEN AVE
Second Line	:	SUITE 4
City	:	MEDFORD
State	:	NY
Zip	:	11763-3745
Country	:	US
Telephone Number	:	631-569-4055
Fax Number	:	631-569-4056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	06/29/2016

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