Provider Demographics
NPI:1205010626
Name:BARATTA, STEPHEN MARK
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:BARATTA
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 1:601 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2827
Mailing Address - Country:US
Mailing Address - Phone:585-343-5662
Mailing Address - Fax:585-343-7480
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2827
Practice Address - Country:US
Practice Address - Phone:585-343-5662
Practice Address - Fax:585-343-7480
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist