Provider Demographics
NPI:1134184237
Name:PESKIN, BARRY D (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:D
Last Name:PESKIN
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 1:10831 REDLAKE ISLE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7861
Mailing Address - Country:US
Mailing Address - Phone:216-973-2844
Mailing Address - Fax:
Practice Address - Street 1:9820 VITRAIL LN
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3816
Practice Address - Country:US
Practice Address - Phone:216-973-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059849P207V00000X
FLME79290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821534Medicaid
OH0821534Medicaid
OHE85368Medicare UPIN