Basic Information
| Provider Information | |||||||||
| NPI: | 1609844828 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRY | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | FRANCES | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 WALNUT AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323887300 | ||||||||
| FaxNumber: | 7323881330 | ||||||||
| Practice Location | |||||||||
| Address1: | 67 WALNUT AVE STE 202 | ||||||||
| Address2: | |||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323887300 | ||||||||
| FaxNumber: | 7323881330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MB71509 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0010X | 25MB07150900 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No ID Information.