Provider Demographics
NPI:1609844828
Name:BARRY, PETER FRANCES (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:FRANCES
Last Name:BARRY
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 1:67 WALNUT AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1640
Mailing Address - Country:US
Mailing Address - Phone:732-388-7300
Mailing Address - Fax:732-388-1330
Practice Address - Street 1:67 WALNUT AVE STE 202
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1640
Practice Address - Country:US
Practice Address - Phone:732-388-7300
Practice Address - Fax:732-388-1330
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB71509207R00000X
NJ25MB07150900207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH91569Medicare UPIN
NJ8546382Medicare ID - Type Unspecified