Provider Demographics
NPI:1669561940
Name:BARR, EILEEN M (DO)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:M
Last Name:BARR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3811
Mailing Address - Country:US
Mailing Address - Phone:631-979-7400
Mailing Address - Fax:631-979-7440
Practice Address - Street 1:100 TERRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3811
Practice Address - Country:US
Practice Address - Phone:631-979-7400
Practice Address - Fax:631-979-7440
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P792184OtherOXFORD
2343357OtherAETNA
AJ49109OtherMDNY
78093OtherVYTRA
24N651Medicare ID - Type Unspecified
AJ49109OtherMDNY
78093OtherVYTRA