Provider Demographics
NPI:1871551333
Name:EBARB, RAYMOND L (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:L
Last Name:EBARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:213 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11796-1800
Mailing Address - Country:US
Mailing Address - Phone:631-563-6205
Mailing Address - Fax:631-563-7718
Practice Address - Street 1:213 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796-1800
Practice Address - Country:US
Practice Address - Phone:631-563-6205
Practice Address - Fax:631-563-7718
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01037276Medicaid
NY01037276Medicaid
NY03E801Medicare ID - Type Unspecified