Healthcare Provider Details

I. General information

NPI: 1679871032
Provider Name (Legal Business Name): BERNADETTE BARRON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRESTHILL PL
SMITHTOWN NY
11787-3703
US

IV. Provider business mailing address

939 JOHNSON AVE
RONKONKOMA NY
11779-6066
US

V. Phone/Fax

Practice location:
  • Phone: 631-764-7133
  • Fax: 631-242-4108
Mailing address:
  • Phone: 631-471-7242
  • Fax: 631-471-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401368-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: