MEDICARE: DR. BARRY SLOAN D.O.

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	MB53521	NJ
2	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	177709-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BS08979210	OTHER	NY	MEDICARE ID NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	BS08979210	OTHER	NY	BC/BS ID

General Provider Information

NPI Number	:	1770578262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY SLOAN D.O.

Provider Business Mailing Address
First Line	:	20 E 46TH ST RM 1102
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-9247
Country	:	US
Telephone Number	:	212-682-5158
Fax Number	:	212-682-7048

Provider Business Practice Location Address
First Line	:	139 FULTON ST RM 700
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-2533
Country	:	US
Telephone Number	:	212-406-0127
Fax Number	:	212-608-1325

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	02/19/2009

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Directions to “ DR. BARRY SLOAN D.O.” Practice Location

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