MEDICARE: DR. ELLIOTT MICHAEL BARISH D.D.S.

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	1223G0001X	General Practice Dentistry	33660	NY

General Provider Information

NPI Number	:	1609963669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOTT MICHAEL BARISH D.D.S.

Provider Business Mailing Address
First Line	:	12 OLD MAMARONECK RD
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2010
Country	:	US
Telephone Number	:	914-949-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 OLD MAMARONECK RD
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2010
Country	:	US
Telephone Number	:	914-949-8899
Fax Number	:

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/08/2007

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