Provider Demographics
NPI:1114936317
Name:BARRY, KAMI QUINN (DO)
Entity Type:Individual
Prefix:DR
First Name:KAMI
Middle Name:QUINN
Last Name:BARRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:KAMI
Other - Middle Name:LYNN
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:76 SOUTHAVEN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3745
Mailing Address - Country:US
Mailing Address - Phone:631-569-4055
Mailing Address - Fax:631-569-4056
Practice Address - Street 1:76 SOUTHAVEN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3745
Practice Address - Country:US
Practice Address - Phone:631-569-4055
Practice Address - Fax:631-569-4056
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine