Healthcare Provider Details

I. General information

NPI: 1639697329
Provider Name (Legal Business Name): LILY MICHELLE BARRES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 651
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

8630 DISRAELI PATH
CICERO NY
13039-7885
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number382753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: