Provider Demographics
NPI:1063428878
Name:BARRITTA, DOMENICA MARIA (MD)
Entity type:Individual
Prefix:MS
First Name:DOMENICA
Middle Name:MARIA
Last Name:BARRITTA
Suffix:
Gender:F
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:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-2337
Mailing Address - Country:US
Mailing Address - Phone:315-422-2933
Mailing Address - Fax:315-701-5608
Practice Address - Street 1:18 OLIVER ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3410
Practice Address - Country:US
Practice Address - Phone:973-645-0000
Practice Address - Fax:973-645-0001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07669400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0036625Medicaid
NJ085265ZDXQMedicare PIN
NJP00858132Medicare PIN
NJ0036625Medicaid
NJH78996Medicare UPIN
NJ085265S1RMedicare PIN