Provider Demographics
NPI:1770578262
Name:SLOAN, BARRY (DO)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:SLOAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 46TH ST RM 1102
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-9247
Mailing Address - Country:US
Mailing Address - Phone:212-682-5158
Mailing Address - Fax:212-682-7048
Practice Address - Street 1:139 FULTON ST RM 700
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2533
Practice Address - Country:US
Practice Address - Phone:212-406-0127
Practice Address - Fax:212-608-1325
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB53521204C00000X
NY177709-1204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBS08979210OtherMEDICARE ID NY
NYBS08979210OtherBC/BS ID
NJ159622Medicare ID - Type UnspecifiedOSTEOPATHIC PHYSICIAN
NYBS08979210OtherBC/BS ID