Healthcare Provider Details

I. General information

NPI: 1740689744
Provider Name (Legal Business Name): IGOR BARSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 S NORTHLAKE DR
HOLLYWOOD FL
33019-1316
US

IV. Provider business mailing address

1149 S NORTHLAKE DR
HOLLYWOOD FL
33019-1316
US

V. Phone/Fax

Practice location:
  • Phone: 917-807-2224
  • Fax: 917-789-9000
Mailing address:
  • Phone: 917-807-2224
  • Fax: 917-789-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number343900000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: