Basic Information
| Provider Information | |||||||||
| NPI: | 1053506063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARELA | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11835 RT 9W | ||||||||
| Address2: | |||||||||
| City: | WEST COXSACKIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121923605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187319000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11835 RT 9W | ||||||||
| Address2: | |||||||||
| City: | WEST COXSACKIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121923605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187319000 | ||||||||
| FaxNumber: | 5187319119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 01/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 207P00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 000414295001 | 01 | NY | BLUE SHIELD NENY | OTHER | WEL75 | 01 | NY | BLUE CROSS MEDICARE PATIE | OTHER | 4937930001 | 01 | NY | MEDICARE DME | OTHER | 10062169 | 01 | NY | CDPHP | OTHER | 857V5 | 01 | NY | BLUE CROSS NON MEDICARE | OTHER |