Provider Demographics
NPI:1952783045
Name:BARNABY, KIMBERLY PATRICE (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PATRICE
Last Name:BARNABY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1832
Mailing Address - Country:US
Mailing Address - Phone:934-213-4803
Mailing Address - Fax:
Practice Address - Street 1:280 UNION AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1832
Practice Address - Country:US
Practice Address - Phone:934-213-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAB0774504-071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY648864745OtherDRIVER'S LICENSE