Healthcare Provider Details

I. General information

NPI: 1225026727
Provider Name (Legal Business Name): KELVIN A BARRY SR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KELVIN A BARRY SR. DPM

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 GROVE AVE STE G
WEST DEPTFORD NJ
08086-2557
US

IV. Provider business mailing address

204 GROVE AVE STE G
WEST DEPTFORD NJ
08086-2557
US

V. Phone/Fax

Practice location:
  • Phone: 877-487-3338
  • Fax:
Mailing address:
  • Phone: 877-487-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00365600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number25MD00365600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00365600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006134
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN006134
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00365600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: