Provider Demographics
NPI:1740242031
Name:SOLOMON, BARRY A (MD, JD, FAAD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD, JD, FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-0121
Mailing Address - Country:US
Mailing Address - Phone:516-364-4200
Mailing Address - Fax:516-590-0267
Practice Address - Street 1:222 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE 228
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-0121
Practice Address - Country:US
Practice Address - Phone:516-364-4200
Practice Address - Fax:516-590-0267
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195658207N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01785368Medicaid
NY01785368Medicaid
NYG22711Medicare UPIN