Provider Demographics
NPI:1124341359
Name:BARRY, JUDITH ANN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:BARRY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ERIN LN
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3461
Mailing Address - Country:US
Mailing Address - Phone:631-928-9004
Mailing Address - Fax:
Practice Address - Street 1:3 ERIN LN
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3461
Practice Address - Country:US
Practice Address - Phone:631-928-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250014-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health