Provider Demographics
NPI:1508852195
Name:BARNES, WILLIAM SYLVAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SYLVAN
Last Name:BARNES
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 1:2110 W COUNTY LINE RD
Mailing Address - Street 2:BLDG 2
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2049
Mailing Address - Country:US
Mailing Address - Phone:732-367-6611
Mailing Address - Fax:732-886-6702
Practice Address - Street 1:2110 W COUNTY LINE RD
Practice Address - Street 2:BLDG 2
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2049
Practice Address - Country:US
Practice Address - Phone:732-367-6611
Practice Address - Fax:732-886-6702
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMDO1720213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2119200Medicaid
T45535Medicare UPIN
NJ456563Medicare ID - Type Unspecified