Healthcare Provider Details

I. General information

NPI: 1669449476
Provider Name (Legal Business Name): PAUL W BARNICKEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 WYCKOFF RD STE 301
EATONTOWN NJ
07724-1887
US

IV. Provider business mailing address

PO BOX 8000 DEPT 596
BUFFALO NY
14267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 848-208-5250
  • Fax: 732-935-1590
Mailing address:
  • Phone: 866-295-0041
  • Fax: 708-342-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04826900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: