Provider Demographics
NPI:1477784718
Name:STABINER, BARRY RICHARD
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:RICHARD
Last Name:STABINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SUFFOLK AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 SUFFOLK AVE
Practice Address - Street 2:STE1
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4389
Practice Address - Country:US
Practice Address - Phone:631-273-3335
Practice Address - Fax:631-273-0310
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2013-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004192156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician