Healthcare Provider Details

I. General information

NPI: 1932277134
Provider Name (Legal Business Name): RAFFI BARSOUMIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 ORANGEBURGH RD
RIVERVALE NJ
07675-6404
US

IV. Provider business mailing address

673 ORANGEBURGH RD
RIVERVALE NJ
07675-6404
US

V. Phone/Fax

Practice location:
  • Phone: 516-287-1120
  • Fax:
Mailing address:
  • Phone: 516-287-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number240858
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: