Provider Demographics
NPI:1407184914
Name:BARRY JANSEN PC
Entity Type:Organization
Organization Name:BARRY JANSEN PC
Other - Org Name:BARRY JANSEN DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-796-2151
Mailing Address - Street 1:15-01 BROADWAY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6003
Mailing Address - Country:US
Mailing Address - Phone:201-796-2151
Mailing Address - Fax:201-796-6676
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:SUITE 11
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:201-796-2151
Practice Address - Fax:201-796-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00124900213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44891Medicare UPIN
NJ5102330001Medicare NSC