Provider Demographics
NPI:1457614208
Name:BARR, ROSEANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1007
Mailing Address - Country:US
Mailing Address - Phone:631-698-1816
Mailing Address - Fax:
Practice Address - Street 1:11 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1007
Practice Address - Country:US
Practice Address - Phone:631-698-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY820872981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist