Provider Demographics
NPI:1285834820
Name:BARAM, ENBAL (RPA-C)
Entity Type:Individual
Prefix:
First Name:ENBAL
Middle Name:
Last Name:BARAM
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3417
Mailing Address - Country:US
Mailing Address - Phone:631-661-2277
Mailing Address - Fax:631-669-2190
Practice Address - Street 1:350 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3417
Practice Address - Country:US
Practice Address - Phone:631-661-2277
Practice Address - Fax:631-669-2190
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant