Provider Demographics
NPI:1124280854
Name:BARSKY, SAMUEL GREGG (DO)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GREGG
Last Name:BARSKY
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 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:561-627-7930
Mailing Address - Fax:561-627-9574
Practice Address - Street 1:4510 PGA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3968
Practice Address - Country:US
Practice Address - Phone:561-627-7930
Practice Address - Fax:561-627-9574
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000813200Medicaid