Provider Demographics
NPI:1942417977
Name:BARRESI, STEPHEN C (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:BARRESI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1422
Mailing Address - Country:US
Mailing Address - Phone:716-456-2149
Mailing Address - Fax:716-456-2628
Practice Address - Street 1:CHD MERIDIAN HEALTHCARE, JEP
Practice Address - Street 2:4720 BAKERST, EXT.
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750
Practice Address - Country:US
Practice Address - Phone:716-456-2149
Practice Address - Fax:716-456-2628
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant