Healthcare Provider Details

I. General information

NPI: 1770153140
Provider Name (Legal Business Name): BETH I BARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294A HILLSIDE AVE
WILLISTON PARK NY
11596-2101
US

IV. Provider business mailing address

244 SYCAMORE ST
WEST HEMPSTEAD NY
11552-2410
US

V. Phone/Fax

Practice location:
  • Phone: 516-888-9962
  • Fax:
Mailing address:
  • Phone: 516-383-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: