Provider Demographics
NPI:1114093291
Name:BARTH, STEPHEN (PT,ATC,CSCS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:BARTH
Suffix:
Gender:M
Credentials:PT,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2351
Mailing Address - Country:US
Mailing Address - Phone:718-370-3500
Mailing Address - Fax:718-979-5236
Practice Address - Street 1:33 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5950
Practice Address - Country:US
Practice Address - Phone:718-982-6340
Practice Address - Fax:718-982-5853
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ2271Medicare PIN