Provider Demographics
NPI:1568502110
Name:BLANK, BARRY PHILIP (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:PHILIP
Last Name:BLANK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1502
Mailing Address - Country:US
Mailing Address - Phone:516-621-4275
Mailing Address - Fax:516-621-4275
Practice Address - Street 1:46 BARBERRY LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1502
Practice Address - Country:US
Practice Address - Phone:516-621-4275
Practice Address - Fax:516-621-4275
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0080201OtherEMPIRE INSURANCE CO.
NY0080201OtherEMPIRE INSURANCE CO.