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General NPI Number Information
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NPI Number | 1871979286
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Entity Type | Individual
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Provider Name | ADAM BARSOUM D.M.D
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Gender | Male
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 140 E 56TH ST APT 1C
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City | NEW YORK
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State | NY
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Zip | 10022-3624
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Country | US
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Telephone | 646-777-2601
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 COMMONWEALTH AVE
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City | ALLSTON
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State | MA
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Zip | 02134-3201
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Country | US
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Telephone | 617-459-1234
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1857010
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 060915
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License Number State | NY
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