Healthcare Provider Details

I. General information

NPI: 1770578262
Provider Name (Legal Business Name): BARRY SLOAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 FULTON ST RM 700
NEW YORK NY
10038-2533
US

IV. Provider business mailing address

20 E 46TH ST RM 1102
NEW YORK NY
10017-9247
US

V. Phone/Fax

Practice location:
  • Phone: 212-406-0127
  • Fax: 212-608-1325
Mailing address:
  • Phone: 212-682-5158
  • Fax: 212-682-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMB53521
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number177709-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: