Basic Information
Provider Information
NPI: 1811183494
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WRIGHT
FirstName: BARRY
MiddleName: N.
NamePrefix: MR.
NameSuffix:  
Credential: PA,MW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 55 WATER STREET
Address2: 2ND FLOOR CRED DEPT
City: NEW YORK
State: NY
PostalCode: 100410004
CountryCode: US
TelephoneNumber: 6466802888
FaxNumber: 5165425556
Practice Location
Address1: 1050 CLOVE RD
Address2:  
City: STATEN ISLAND
State: NY
PostalCode: 103013627
CountryCode: US
TelephoneNumber: 7188166440
FaxNumber: 7188163611
Other Information
ProviderEnumerationDate: 09/18/2007
LastUpdateDate: 10/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X000803NYY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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