Provider Demographics
NPI:1932134087
Name:BARNOSKI, EDWARD JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:BARNOSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MEDFORD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1230
Mailing Address - Country:US
Mailing Address - Phone:631-366-3369
Mailing Address - Fax:631-366-2043
Practice Address - Street 1:77 MEDFORD AVE STE D
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1230
Practice Address - Country:US
Practice Address - Phone:631-366-3369
Practice Address - Fax:631-366-3369
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011687-1103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01503557Medicaid
NY01503557Medicaid