Healthcare Provider Details

I. General information

NPI: 1851914246
Provider Name (Legal Business Name): BARUCH MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 12/21/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W 34TH ST # 402A
NEW YORK NY
10001-3011
US

IV. Provider business mailing address

1 W 34TH ST # 402A
NEW YORK NY
10001-3011
US

V. Phone/Fax

Practice location:
  • Phone: 646-725-4600
  • Fax:
Mailing address:
  • Phone: 646-725-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARUCH KIM
Title or Position: PHYSICIAN
Credential: DO
Phone: 917-362-3687