Provider Demographics
NPI:1881756633
Name:BARSKY, GARY JAY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JAY
Last Name:BARSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 N YORK ST
Mailing Address - Street 2:STE 205
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2367
Mailing Address - Country:US
Mailing Address - Phone:630-832-8111
Mailing Address - Fax:630-832-8145
Practice Address - Street 1:386 N YORK ST
Practice Address - Street 2:STE 205
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2367
Practice Address - Country:US
Practice Address - Phone:630-832-8111
Practice Address - Fax:630-832-8145
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056902207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10574268OtherCAQH
IL2201537OtherBLUE CROSS BLUE SHIELD
IL036-056902OtherIL STATE LICENSE NUMBER
IL036056902Medicaid
IL1881756633OtherNPI
IL1881756633OtherNPI
IL10574268OtherCAQH
IL036056902Medicaid