Basic Information
Provider Information
NPI: 1073020269
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARNETT
FirstName: RICHARD
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 ROBERT WOOD JOHNSON PL MEB 104
Address2:  
City: NEW BRUNSWICK
State: NJ
PostalCode: 089011928
CountryCode: US
TelephoneNumber: 7322358717
FaxNumber:  
Practice Location
Address1: 1 ROBERT WOOD JOHNSON PL MEB 104
Address2:  
City: NEW BRUNSWICK
State: NJ
PostalCode: 08901
CountryCode: US
TelephoneNumber: 7322358717
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/09/2018
LastUpdateDate: 05/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
247200000X  N Technologists, Technicians & Other Technical Service ProvidersTechnician, Other 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207P00000X25MB10568900NJY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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