=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376782748
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA B JURIM DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2009
-----------------------------------------------------
Last Update Date | 03/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7952 JERICHO TPKE
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11797-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-677-9010
-----------------------------------------------------
Fax | 516-677-9011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 E 30TH ST APT 3G
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-8295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-677-9010
-----------------------------------------------------
Fax | 516-677-9011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 052138
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------