MEDICARE: M L BARRERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01162800	NJ

General Provider Information

NPI Number	:	1194830430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M L BARRERA

Provider Business Mailing Address
First Line	:	418 CHESTNUT ST
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-9306
Country	:	US
Telephone Number	:	908-810-9002
Fax Number	:	908-810-9012

Provider Business Practice Location Address
First Line	:	418 CHESTNUT ST
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-9306
Country	:	US
Telephone Number	:	908-810-9002
Fax Number	:	908-810-9012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	10/17/2007

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Directions to “ M L BARRERA ” Practice Location

Language	Start Address	Practice Location

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