Healthcare Provider Details

I. General information

NPI: 1467831032
Provider Name (Legal Business Name): BARAK SERED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 FULTON ST
BROOKLYN NY
11216-2505
US

IV. Provider business mailing address

101 W 137TH ST APT 4
NEW YORK NY
10030-2531
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-4500
  • Fax:
Mailing address:
  • Phone: 617-953-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number288403
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: