Healthcare Provider Details

I. General information

NPI: 1174447361
Provider Name (Legal Business Name): BARRY MOHAN DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FRANKLIN AVE
VALLEY STREAM NY
11580-2145
US

IV. Provider business mailing address

799 DOUGHTY AVE
FRANKLIN SQUARE NY
11010-3215
US

V. Phone/Fax

Practice location:
  • Phone: 516-256-6000
  • Fax:
Mailing address:
  • Phone: 407-808-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF433690-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: