Provider Demographics
NPI:1194830430
Name:BARRERA, M L
Entity Type:Individual
Prefix:
First Name:M
Middle Name:L
Last Name:BARRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9306
Mailing Address - Country:US
Mailing Address - Phone:908-810-9002
Mailing Address - Fax:908-810-9012
Practice Address - Street 1:418 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9306
Practice Address - Country:US
Practice Address - Phone:908-810-9002
Practice Address - Fax:908-810-9012
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01162800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ106375T56Medicare PIN