Provider Demographics
NPI:1902890502
Name:WILDFEIR, BARBARA RUSSELL (FNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:RUSSELL
Last Name:WILDFEIR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHESHIRE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1214
Mailing Address - Country:US
Mailing Address - Phone:631-549-1933
Mailing Address - Fax:
Practice Address - Street 1:1500 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1100
Practice Address - Country:US
Practice Address - Phone:718-730-1004
Practice Address - Fax:718-892-6469
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-333377-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05303HMedicare ID - Type Unspecified
NY0032G1Medicare ID - Type Unspecified
NYP63207Medicare UPIN