Healthcare Provider Details

I. General information

NPI: 1750400941
Provider Name (Legal Business Name): ANDREA DANIELLE BARKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EWING ST SUITE B-19
PRINCETON NJ
08540-2757
US

IV. Provider business mailing address

10 FORRESTAL RD S
PRINCETON NJ
08540-6666
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-2230
  • Fax: 609-924-5006
Mailing address:
  • Phone: 609-924-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: