Provider Demographics
NPI:1275602583
Name:BARABAN, BRIAN D
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:BARABAN
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 1:1305 MIDDLE COUNTRY RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2554
Mailing Address - Country:US
Mailing Address - Phone:631-698-2267
Mailing Address - Fax:631-698-2232
Practice Address - Street 1:1305 MIDDLE COUNTRY RD
Practice Address - Street 2:STE 1
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2554
Practice Address - Country:US
Practice Address - Phone:631-698-2267
Practice Address - Fax:631-698-2232
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002270213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0057872OtherGHI
PJ5481OtherBLUE CROSS
480529OtherUNITED HEALTHCARE COMMERC
10231OtherVYTRA
NY00414411Medicaid
3C6645OtherHEALTHNET
5253490001OtherDMERC
P490336OtherOXFORD
P022708OtherWORKERS COMP
070016923OtherRAILROAD MEDICARE
100048052901OtherUNITED HEALTHCARE GOVERNM
10231OtherVYTRA
P25411Medicare ID - Type Unspecified