Provider Demographics
NPI:1902972508
Name:REILLY, BARBARA MICHALAK (DO)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:MICHALAK
Last Name:REILLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 GLEN RIDGE DRIVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-722-8554
Mailing Address - Fax:856-451-7228
Practice Address - Street 1:333 IRVING AVENUE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302
Practice Address - Country:US
Practice Address - Phone:856-575-4155
Practice Address - Fax:856-451-7228
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB261002084N0400X
NJMB0261002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6991203Medicaid
G09532Medicare UPIN
NJ646884Medicare ID - Type Unspecified