Provider Demographics
NPI:1396801031
Name:BARRIENTOS, JACQUELINE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:BARRIENTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LAKEVILLE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1122
Mailing Address - Country:US
Mailing Address - Phone:516-470-4050
Mailing Address - Fax:516-470-4250
Practice Address - Street 1:4306 ALTON RD FL 3
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2840
Practice Address - Country:US
Practice Address - Phone:305-535-3310
Practice Address - Fax:305-535-3324
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238640207RH0003X
FLME154737207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY238640OtherLICENSE
CT36036OtherCT CSR
CT043524OtherCT PHYSICIAN LICENSE
CT043524OtherCT PHYSICIAN LICENSE