Healthcare Provider Details

I. General information

NPI: 1053506063
Provider Name (Legal Business Name): CHRISTOPHER PAUL BARELA RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 RT 9W
WEST COXSACKIE NY
12192-3605
US

IV. Provider business mailing address

11835 RT 9W
WEST COXSACKIE NY
12192-3605
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-9000
  • Fax: 518-731-9119
Mailing address:
  • Phone: 518-731-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number207P00000X
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: