MEDICARE: BARRY NOSKOW DDS, PC

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	261QD0000X	Dental Clinic/Center	028971	NY

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
2	6682510001	OTHER		NSC PTAN

General Provider Information

NPI Number	:	1447236971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRY NOSKOW DDS, PC

Provider Business Mailing Address
First Line	:	1303 53RD ST
Second Line	:	# 139
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3823
Country	:	US
Telephone Number	:	718-438-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5824 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4623
Country	:	US
Telephone Number	:	718-438-8400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY NOSKOW
Credential	:	D.D.S.
Telephone Number	:	718-435-3522

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/24/2012

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