Healthcare Provider Details

I. General information

NPI: 1619798543
Provider Name (Legal Business Name): ANNMARIE BARSOUM OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 ROUTE 46 STE 105
CLIFTON NJ
07013-2448
US

IV. Provider business mailing address

1033 ROUTE 46 STE 105
CLIFTON NJ
07013-2448
US

V. Phone/Fax

Practice location:
  • Phone: 973-949-5777
  • Fax:
Mailing address:
  • Phone: 973-949-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00732600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License Number27OM00200100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: