Provider Demographics
NPI:1730961061
Name:ALLIED MEDICAL OF NY PC
Entity type:Organization
Organization Name:ALLIED MEDICAL OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRAVECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-942-6005
Mailing Address - Street 1:510 HAMBURG TPKE STE 102
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2033
Mailing Address - Country:US
Mailing Address - Phone:973-942-6005
Mailing Address - Fax:973-942-6009
Practice Address - Street 1:1 OLD COUNTRY RD STE 285
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1824
Practice Address - Country:US
Practice Address - Phone:973-942-6005
Practice Address - Fax:973-942-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty