Provider Demographics
NPI:1588926604
Name:BARTH, CARLY ERIN GLICK (MD)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:ERIN GLICK
Last Name:BARTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ERIN
Other - Last Name:GLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1488 WANTAGH AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2204
Mailing Address - Country:US
Mailing Address - Phone:516-785-6800
Mailing Address - Fax:
Practice Address - Street 1:1488 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793
Practice Address - Country:US
Practice Address - Phone:516-785-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292783207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology