Basic Information
| Provider Information | |||||||||
| NPI: | 1548769029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAFFI BARSOUMIAN MD MEDICAL TREATMENTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 228 E ROUTE 59 STE 248 | ||||||||
| Address2: | |||||||||
| City: | NANUET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109542905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162871120 | ||||||||
| FaxNumber: | 7188456464 | ||||||||
| Practice Location | |||||||||
| Address1: | 15817 97TH ST | ||||||||
| Address2: | |||||||||
| City: | HOWARD BEACH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114143228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188455252 | ||||||||
| FaxNumber: | 7188456464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2018 | ||||||||
| LastUpdateDate: | 02/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | BARSOUMIAN | ||||||||
| AuthorizedOfficialFirstName: | RAFFI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5162871120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 240858 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.