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General NPI Number Information
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NPI Number | 1811059967
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Entity Type | Individual
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Provider Name | IVAN DARIO BARAQUE MD
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 1532 UNION ST
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City | SCHENECTADY
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State | NY
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Zip | 12309-6002
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Country | US
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Telephone | 347-952-0051
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Fax | 518-786-1875
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Provider Business Mailing Address
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Address Line | 4 WOODCREST CT
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City | WEST NYACK
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State | NY
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Zip | 10994-1213
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Country | US
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Telephone | 347-952-0051
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Fax | 518-786-1875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08711300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 161270
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License Number State | NY
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