Provider Demographics
NPI:1073506994
Name:BARBER, JEAN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARY
Last Name:BARBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:506 LENOX AVE
Mailing Address - Street 2:MLK BUILDING ROOM 3122
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-4450
Mailing Address - Fax:212-939-4405
Practice Address - Street 1:506 LENOX AVE
Practice Address - Street 2:ROOM 3122 MLK BUILDING
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-4450
Practice Address - Fax:212-939-4405
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198432208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8020604Medicaid
NJG66051Medicare UPIN
NJ028642Medicare PIN