Provider Demographics
NPI:1386949956
Name:BARNES, JASON R
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:R
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, LAC
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:FREMONT CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12736-0066
Mailing Address - Country:US
Mailing Address - Phone:845-701-1218
Mailing Address - Fax:
Practice Address - Street 1:21 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723
Practice Address - Country:US
Practice Address - Phone:845-887-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030820225700000X
NY006255171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist