Provider Demographics
NPI:1295750503
Name:BARIE, JACOB JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JOSEPH
Last Name:BARIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:RADIOLOGIC ASSOCIATES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-1258
Mailing Address - Fax:845-343-0617
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:ORANGE REGIONAL MEDICAL CENTER-RADIOLOGY DEPT
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-333-1258
Practice Address - Fax:845-343-0617
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-08-05
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Provider Licenses
StateLicense IDTaxonomies
NY1012082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00580718Medicaid
NYC11729Medicare UPIN
NY675621Medicare ID - Type Unspecified