MEDICARE: DR. THOMAS K BARLIS DPM

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	213E00000X	Podiatrist	N003884	NY
2	213E00000X	Podiatrist	25MD00171500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376540021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS K BARLIS DPM

Provider Business Mailing Address
First Line	:	2747 CRESCENT ST
Second Line	:	SUITE 204
City	:	ASTORIA
State	:	NY
Zip	:	11102-3142
Country	:	US
Telephone Number	:	718-956-0700
Fax Number	:	718-956-4582

Provider Business Practice Location Address
First Line	:	2747 CRESCENT ST
Second Line	:	SUITE 204
City	:	ASTORIA
State	:	NY
Zip	:	11102-3142
Country	:	US
Telephone Number	:	718-956-0700
Fax Number	:	718-956-4582

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/06/2011

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