Provider Demographics
NPI:1639340011
Name:BARCLAY, PAMELIA J (NP)
Entity Type:Individual
Prefix:
First Name:PAMELIA
Middle Name:J
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAMELIA
Other - Middle Name:JUNE
Other - Last Name:BARRINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 WEST MAIN STREET
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-422-6166
Mailing Address - Fax:631-422-6266
Practice Address - Street 1:500 WEST MAIN STREET
Practice Address - Street 2:SUITE 116
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-422-6166
Practice Address - Fax:631-422-6266
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334468-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400079586Medicare PIN