Basic Information
| Provider Information | |||||||||
| NPI: | 1770970287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARAKAT | ||||||||
| FirstName: | MOHAMED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 82-68 164TH STREET | ||||||||
| Address2: | INTERNAL MEDICINE DEPT | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11432 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 82-68 164TH STREET | ||||||||
| Address2: | INTERNAL MEDICINE DEPT | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188834080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0100X | 30368 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.