Provider Demographics
NPI:1518248657
Name:BARNA, KELLY M (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:BARNA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:DEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:150 E. SUNRISE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-289-4800
Mailing Address - Fax:
Practice Address - Street 1:150 E. SUNRISE HIGHWAY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-289-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2644232085B0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program