Provider Demographics
NPI:1376540021
Name:BARLIS, THOMAS K (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:BARLIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 CRESCENT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3142
Mailing Address - Country:US
Mailing Address - Phone:718-956-0700
Mailing Address - Fax:718-956-4582
Practice Address - Street 1:2747 CRESCENT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3142
Practice Address - Country:US
Practice Address - Phone:718-956-0700
Practice Address - Fax:718-956-4582
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003884213E00000X
NJ25MD00171500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0953219Medicaid
NY0953219Medicaid
NY95184Medicare ID - Type Unspecified