Provider Demographics
NPI:1952359960
Name:BARRY, THERESE M (DO)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:BARRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 LACEY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1200
Mailing Address - Country:US
Mailing Address - Phone:609-242-6700
Mailing Address - Fax:609-242-6701
Practice Address - Street 1:833 LACEY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1200
Practice Address - Country:US
Practice Address - Phone:609-242-6700
Practice Address - Fax:609-242-6701
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB06877400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7989504Medicaid
NJD07611OtherCDS
NJD07611OtherCDS
NJ7989504Medicaid
G96631Medicare UPIN