MEDICARE: YOSEF BARAS RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	015515	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015515	OTHER	NY	PA LICENSE

General Provider Information

NPI Number	:	1194081125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOSEF BARAS RPA-C

Provider Business Mailing Address
First Line	:	200 WALLABOUT ST
Second Line	:	SUITE 1C
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5543
Country	:	US
Telephone Number	:	718-486-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WALLABOUT ST
Second Line	:	SUITE 1C
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5543
Country	:	US
Telephone Number	:	718-486-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	10/29/2012

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