Healthcare Provider Details

I. General information

NPI: 1518608561
Provider Name (Legal Business Name): ANDREW ELIAS BARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PAULISON AVE STE 2
CLIFTON NJ
07011-3600
US

IV. Provider business mailing address

1111 PAULISON AVE STE 2
CLIFTON NJ
07011-3600
US

V. Phone/Fax

Practice location:
  • Phone: 848-959-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38793
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA13268200
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA13268200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: