Provider Demographics
NPI:1174793673
Name:BARRY, ELIZABETH JACQUELINE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JACQUELINE
Last Name:BARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2062
Mailing Address - Country:US
Mailing Address - Phone:631-880-3721
Mailing Address - Fax:
Practice Address - Street 1:215 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2062
Practice Address - Country:US
Practice Address - Phone:631-880-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576117-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical