Basic Information
| Provider Information | |||||||||
| NPI: | 1578862587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAFFI BARSOUMIAN MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BLUE HILL PLZ | ||||||||
| Address2: | |||||||||
| City: | PEARL RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109653104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162871120 | ||||||||
| FaxNumber: | 8884115515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1895 WALT WHITMAN RD | ||||||||
| Address2: | |||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117473031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162871120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2011 | ||||||||
| LastUpdateDate: | 03/17/2011 | ||||||||
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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: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 240858 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.