Provider Demographics
NPI:1659419695
Name:FORMAN, BARBARA STEPHANIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:STEPHANIE
Last Name:FORMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3807
Mailing Address - Country:US
Mailing Address - Phone:631-691-0655
Mailing Address - Fax:631-691-0655
Practice Address - Street 1:9 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3807
Practice Address - Country:US
Practice Address - Phone:631-691-0655
Practice Address - Fax:631-691-0655
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor