Provider Demographics
NPI:1033280367
Name:BARBOSSA, STACEY (DC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:BARBOSSA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1865
Mailing Address - Country:US
Mailing Address - Phone:201-435-0900
Mailing Address - Fax:201-435-0911
Practice Address - Street 1:1637 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1865
Practice Address - Country:US
Practice Address - Phone:201-435-0900
Practice Address - Fax:201-435-0911
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00454600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBA548872Medicare ID - Type Unspecified
NJU52557Medicare UPIN