Provider Demographics
NPI:1700413168
Name:BARBER, DANIELLA JO (DO)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:JO
Last Name:BARBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 HEDGEROW DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5037
Mailing Address - Country:US
Mailing Address - Phone:206-755-4484
Mailing Address - Fax:
Practice Address - Street 1:910 SYLVAN AVE STE 210
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3305
Practice Address - Country:US
Practice Address - Phone:201-408-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11862700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0954322Medicaid