Provider Demographics
NPI:1154441004
Name:DE FEO, BARBARA ANN (RN NPP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:DE FEO
Suffix:
Gender:F
Credentials:RN NPP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:DE FEO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NPP
Mailing Address - Street 1:107 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2337
Mailing Address - Country:US
Mailing Address - Phone:631-666-1615
Mailing Address - Fax:631-666-1719
Practice Address - Street 1:107 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11742
Practice Address - Country:US
Practice Address - Phone:631-666-1615
Practice Address - Fax:631-666-1719
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4008981363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65124097Medicare UPIN
NY116461Medicare ID - Type Unspecified