Provider Demographics
NPI:1013015288
Name:BARANETSKY, ADRIAN (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:BARANETSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 FOREST DR S
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2310
Mailing Address - Country:US
Mailing Address - Phone:973-376-2212
Mailing Address - Fax:
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-9008
Practice Address - Country:US
Practice Address - Phone:718-780-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA041592002085R0202X
NY1623752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1657402Medicaid
NJ294186OtherAMERIGROUP
NY01196670Medicaid
NJ4106489OtherGHI
NJ60016051OtherHORIZON NJ HEALTH
NJA60546Medicare UPIN
NY01196670Medicaid
11E44X0441Medicare PIN