Provider Demographics
NPI:1104802917
Name:KING, BARBARA (PA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:GENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1026 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3449
Mailing Address - Country:US
Mailing Address - Phone:716-712-0851
Mailing Address - Fax:716-712-0852
Practice Address - Street 1:1026 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3449
Practice Address - Country:US
Practice Address - Phone:716-712-0851
Practice Address - Fax:716-712-0852
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026703701OtherUNIVERA
NY02166136Medicaid
NY9512405OtherIHA
NY000570325005OtherBC/BS
P35786Medicare UPIN
P00140094Medicare PIN
NY00026703701OtherUNIVERA