Healthcare Provider Details

I. General information

NPI: 1679583322
Provider Name (Legal Business Name): THEODORE BARRETT JR. MD, FACOG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

140 BERGEN ST
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2746
  • Fax: 973-972-2856
Mailing address:
  • Phone: 973-972-2746
  • Fax: 973-972-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA06056100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number25MA06056100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA06056100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: