Provider Demographics
NPI:1588875108
Name:BARRETT, MAXINE A (ANP)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:A
Last Name:BARRETT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:MAXINE
Other - Middle Name:A
Other - Last Name:BARRETT-ANTOINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:198 MATLOOK PL
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6451
Mailing Address - Country:US
Mailing Address - Phone:732-873-0801
Mailing Address - Fax:212-263-8434
Practice Address - Street 1:560 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-8562
Practice Address - Fax:212-263-8434
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301582-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health