Provider Demographics
NPI:1093849630
Name:BARBER, NATHANIEL AUGUSTUS (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:AUGUSTUS
Last Name:BARBER
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 1:109 W ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5015
Mailing Address - Country:US
Mailing Address - Phone:201-833-4555
Mailing Address - Fax:201-332-4122
Practice Address - Street 1:8 BALDWIN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3154
Practice Address - Country:US
Practice Address - Phone:201-332-4110
Practice Address - Fax:201-332-4122
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8198608Medicaid
NJ544018Medicare ID - Type Unspecified
NJ8198608Medicaid