Provider Demographics
NPI:1851386411
Name:BARISH, MATTHEW ADAM (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ADAM
Last Name:BARISH
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 1:19A LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1425
Mailing Address - Country:US
Mailing Address - Phone:631-470-9660
Mailing Address - Fax:561-658-4635
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:718-830-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG880662085R0202X
MA770572085R0202X
NY243049-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA7365OtherHARVARD PILGRIM
MAJ17676OtherBLUE CROSS/BLUE SHIELD
MA77057OtherTUFTS HEALTH CARE
MA3165701Medicaid
MAJ17676OtherBLUE CROSS/BLUE SHIELD
MAA22308Medicare ID - Type Unspecified