Healthcare Provider Details

I. General information

NPI: 1215993605
Provider Name (Legal Business Name): JONATHAN ALEXANDER BARBER SR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MAIN ST
OAKFIELD NY
14125-1014
US

IV. Provider business mailing address

4 MIX PL
BATAVIA NY
14020-1911
US

V. Phone/Fax

Practice location:
  • Phone: 585-948-8077
  • Fax: 585-948-9159
Mailing address:
  • Phone: 585-230-4579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3343401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: