Provider Demographics
NPI:1568050912
Name:BARNETT, ORISA AYOKA
Entity Type:Individual
Prefix:
First Name:ORISA
Middle Name:AYOKA
Last Name:BARNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ORISA
Other - Middle Name:AYOKA
Other - Last Name:GEORGE-EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 E 92ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1530
Mailing Address - Country:US
Mailing Address - Phone:917-783-0019
Mailing Address - Fax:
Practice Address - Street 1:11 E 92ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1530
Practice Address - Country:US
Practice Address - Phone:917-783-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022660225700000X
NY022660-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY123456789Medicaid