Provider Demographics
NPI:1043405103
Name:WHITNEY, BARBARA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 DEER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1126
Mailing Address - Country:US
Mailing Address - Phone:631-254-6206
Mailing Address - Fax:
Practice Address - Street 1:672 N WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1677
Practice Address - Country:US
Practice Address - Phone:631-957-2200
Practice Address - Fax:631-957-4619
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant