Basic Information
Provider Information | |||||||||
NPI: | 1427072446 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARBA | ||||||||
FirstName: | JOSE | ||||||||
MiddleName: | PARAS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 224 | ||||||||
Address2: |   | ||||||||
City: | SADDLE RIVER | ||||||||
State: | NJ | ||||||||
PostalCode: | 074580224 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6073242340 | ||||||||
FaxNumber: | 6073241697 | ||||||||
Practice Location | |||||||||
Address1: | 4605 MACCORKLE AVE SW | ||||||||
Address2: |   | ||||||||
City: | SOUTH CHARLESTON | ||||||||
State: | WV | ||||||||
PostalCode: | 253091311 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3047663668 | ||||||||
FaxNumber: | 3047665654 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2006 | ||||||||
LastUpdateDate: | 09/28/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 139832 | NY | Y |   | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 27180 | WV | N |   | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
ID | Type | State | Issuer | Description | 00697452 | 05 | NY |   | MEDICAID |