Provider Demographics
NPI:1568442390
Name:MENNA, BARRY L (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:MENNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LAKERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3961
Mailing Address - Country:US
Mailing Address - Phone:516-242-9245
Mailing Address - Fax:
Practice Address - Street 1:1301 PLEASANT VALLEY RD STE 300
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-7830
Practice Address - Fax:270-417-7839
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2281142084N0400X
KY040652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100450380Medicaid
KY7100450380Medicaid
KYK221960Medicare PIN
NYI22293Medicare UPIN