Healthcare Provider Details

I. General information

NPI: 1871747337
Provider Name (Legal Business Name): ANNIKA S BARRITEAU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 HATFIELD LANE SUITE 202
GOSHEN NY
10924-6735
US

IV. Provider business mailing address

5A MEDICAL PARK DRIVE
POMONA NY
10970-3516
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-3656
  • Fax: 845-291-3936
Mailing address:
  • Phone: 845-362-0075
  • Fax: 845-362-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: