Provider Demographics
NPI:1710950365
Name:BARRY, JOSEPH T (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:BARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 W GENESEE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2162
Mailing Address - Country:US
Mailing Address - Phone:315-487-8109
Mailing Address - Fax:
Practice Address - Street 1:5415 W GENESEE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2162
Practice Address - Country:US
Practice Address - Phone:315-487-8109
Practice Address - Fax:315-487-5680
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1717601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01536832Medicaid
NY060009321Medicare PIN
NY01536832Medicaid
NE55809DMedicare ID - Type Unspecified