Provider Demographics
NPI:1790866002
Name:BARABAN, WENDY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:A
Last Name:BARABAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 MIDDLE COUNTRY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2554
Mailing Address - Country:US
Mailing Address - Phone:631-698-2267
Mailing Address - Fax:631-698-2232
Practice Address - Street 1:1305 MIDDLE COUNTRY RD STE 1
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2554
Practice Address - Country:US
Practice Address - Phone:631-698-2267
Practice Address - Fax:631-698-2232
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005620213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02417292Medicaid
NYU80599Medicare UPIN
NYPB80510Medicare ID - Type Unspecified