Provider Demographics
NPI:1922160381
Name:SHARIF BAKARI, LATANYA R (DC)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:R
Last Name:SHARIF BAKARI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 STELTON RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3879
Mailing Address - Country:US
Mailing Address - Phone:732-968-3030
Mailing Address - Fax:732-424-1711
Practice Address - Street 1:690 STELTON RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3879
Practice Address - Country:US
Practice Address - Phone:732-968-3030
Practice Address - Fax:732-424-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00465300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U99517Medicare UPIN