Provider Demographics
NPI:1508173964
Name:PELCZAR, BARBARA THERESA (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:THERESA
Last Name:PELCZAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1451
Mailing Address - Country:US
Mailing Address - Phone:631-591-1026
Mailing Address - Fax:
Practice Address - Street 1:700 OSBORNE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2912
Practice Address - Country:US
Practice Address - Phone:631-369-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330017-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool