MEDICARE: MRS. CHRISTINE C BARBARA 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	2255A2300X	Athletic Trainer	001069-1	NY

General Provider Information

NPI Number	:	1942867924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE C BARBARA ATC

Provider Business Mailing Address
First Line	:	53 DUDLEY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4003
Country	:	US
Telephone Number	:	917-974-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 DUDLEY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4003
Country	:	US
Telephone Number	:	917-974-2626
Fax Number	:

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

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	05/24/2019

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