Healthcare Provider Details

I. General information

NPI: 1306172713
Provider Name (Legal Business Name): SBARRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MAURIELLO DR
WATERFORD WORKS NJ
08089-2411
US

IV. Provider business mailing address

5 MAURIELLO DR
WATERFORD WORKS NJ
08089-2411
US

V. Phone/Fax

Practice location:
  • Phone: 856-719-8851
  • Fax:
Mailing address:
  • Phone: 856-719-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number26NR09547900
License Number StateNJ

VIII. Authorized Official

Name: SUSAN BARRY
Title or Position: RN
Credential:
Phone: 856-719-8851