Provider Demographics
NPI:1558957498
Name:BARAHONA, BYRON
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:
Last Name:BARAHONA
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 1:6419 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4109
Mailing Address - Country:US
Mailing Address - Phone:551-225-4440
Mailing Address - Fax:
Practice Address - Street 1:6419 PARK AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-4109
Practice Address - Country:US
Practice Address - Phone:551-225-4440
Practice Address - Fax:201-854-3535
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03190600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist