Provider Demographics
NPI:1356417661
Name:BARON, JILL (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:BARON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:KRILOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:804 VALLEY PLAZA
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-797-1100
Mailing Address - Fax:607-797-9514
Practice Address - Street 1:804 VALLEY PLAZA
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-797-1100
Practice Address - Fax:607-797-9514
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1714812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01871145Medicaid
NYBB0409Medicare ID - Type Unspecified