Healthcare Provider Details

I. General information

NPI: 1750743092
Provider Name (Legal Business Name): JESSICA BARENBOIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NORTHERN BLVD STE 324-1281
ALBANY NY
12204-1000
US

IV. Provider business mailing address

350 NORTHERN BLVD STE 324-1281
ALBANY NY
12204-1000
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-7645
  • Fax: 646-450-7645
Mailing address:
  • Phone: 646-450-7645
  • Fax: 646-450-7645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number307677
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number307677
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD19981
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number307677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: