Provider Demographics
NPI:1891787792
Name:PILGRIM, BARRIE JOSEPH (DC, PA-C)
Entity Type:Individual
Prefix:
First Name:BARRIE
Middle Name:JOSEPH
Last Name:PILGRIM
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 METROPOLITAN PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5842
Mailing Address - Country:US
Mailing Address - Phone:315-870-9370
Mailing Address - Fax:315-558-6611
Practice Address - Street 1:6 EUCLID AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1257
Practice Address - Country:US
Practice Address - Phone:607-753-9076
Practice Address - Fax:607-753-7506
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030070111NR0400X
VA0110-005907363A00000X
NY021318-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA288992OtherANTHEM BCBS
DCG850-0001OtherCAREFIRST BCBS DCMETRO
VA288992OtherANTHEM BCBS
VA288992OtherANTHEM BCBS