=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134180052
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL BARBAROTTO DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2006
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 EMPIRE DR
-----------------------------------------------------
City | RENSSELAER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12144-5730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-286-4899
-----------------------------------------------------
Fax | 518-286-4859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 689
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12181-0689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-268-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 178487
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------