Provider Demographics
NPI:1225124704
Name:BARBAZAN SILVA, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:BARBAZAN SILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1234
Mailing Address - Country:US
Mailing Address - Phone:212-828-1200
Mailing Address - Fax:212-831-7558
Practice Address - Street 1:1111 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1234
Practice Address - Country:US
Practice Address - Phone:212-828-1200
Practice Address - Fax:212-831-7558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01692626Medicaid
NY63827WT601Medicare PIN
NY01692626Medicaid