Provider Demographics
NPI:1942376801
Name:BARRON, MARCI (CERTIFIED ORTHOTIC F)
Entity Type:Individual
Prefix:MS
First Name:MARCI
Middle Name:
Last Name:BARRON
Suffix:
Gender:F
Credentials:CERTIFIED ORTHOTIC F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 ANDERSON AVE
Mailing Address - Street 2:SUITE 18N HAVE SHOES WILL TRAVEL LLC
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010
Mailing Address - Country:US
Mailing Address - Phone:201-917-3011
Mailing Address - Fax:201-917-3645
Practice Address - Street 1:770 ANDERSON AVE
Practice Address - Street 2:SUITE 18N HAVE SHOES WILL TRAVEL LLC
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010
Practice Address - Country:US
Practice Address - Phone:201-917-3011
Practice Address - Fax:201-917-3645
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRF001865332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0016489Medicaid
NJ0016489Medicaid