Provider Demographics
NPI:1447256508
Name:OBADIAH, BARRY S (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:OBADIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2892
Mailing Address - Country:US
Mailing Address - Phone:718-932-6000
Mailing Address - Fax:718-932-3194
Practice Address - Street 1:2318 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2892
Practice Address - Country:US
Practice Address - Phone:718-932-6000
Practice Address - Fax:718-932-3194
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199214207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02457358Medicaid
NYG400001072Medicare PIN
NY01HCRSMedicare PIN
NY05618IMedicare PIN
NY02457358Medicaid