Provider Demographics
NPI:1306044128
Name:BARSKY DERMATOLOGICAL ASSOCIATES CHARTERED
Entity Type:Organization
Organization Name:BARSKY DERMATOLOGICAL ASSOCIATES CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:NESAVAS-BARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-571-2630
Mailing Address - Street 1:120 OAK BROOK CENTER MALL
Mailing Address - Street 2:#316 AND #318
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1806
Mailing Address - Country:US
Mailing Address - Phone:630-571-2630
Mailing Address - Fax:630-571-3781
Practice Address - Street 1:120 OAK BROOK CENTER MALL
Practice Address - Street 2:#316 AND #318
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1806
Practice Address - Country:US
Practice Address - Phone:630-571-2630
Practice Address - Fax:630-571-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL745760Medicare ID - Type Unspecified