Provider Demographics
NPI:1376603456
Name:ROOT, BARRY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:ROOT
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:GLEN COVE HOSPITAL DEPT OF PM AND R
Mailing Address - Street 2:101 ST. ANDREWS LANE
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-674-7500
Mailing Address - Fax:
Practice Address - Street 1:GLEN COVE HOSPITAL DEPT OF PM AND R
Practice Address - Street 2:101 ST. ANDREWS LANE
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-674-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA167868208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation