MEDICARE: MR. RONNIE PHILLIP BARNES ATC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1437128022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONNIE PHILLIP BARNES ATC

Provider Business Mailing Address
First Line	:	77 GLEN ROCK RD
Second Line	:
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1635
Country	:	US
Telephone Number	:	201-939-5682
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 STATE ROUTE 120
Second Line	:	NEW YORK FOOTBALL GIANTS
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073
Country	:	US
Telephone Number	:	201-939-5682
Fax Number	:

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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