1578556437 NPI number — SUSAN BARASCH MD

Table of content: SUSAN BARASCH MD (NPI 1578556437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578556437 NPI number — SUSAN BARASCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARASCH
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578556437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 STIRLING RD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07059-5751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-755-5437
Provider Business Mailing Address Fax Number:
908-755-6905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 STIRLING RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07059-5751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-755-5437
Provider Business Practice Location Address Fax Number:
908-755-6905
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  25MA06097800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00019972 . This is a "HIGH MARK PA BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 010060978NJ01 . This is a "MULTIPLAN PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1K3073 . This is a "HEALTH NET PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 78J801 . This is a "EMPIRE PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 503377 . This is a "AETNA HMO PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: TP088 . This is a "OXFORD PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0725154000 . This is a "AMERIHEALTH HMO PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 199972 . This is a "AMERIHEALTH PPO PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2468321006 . This is a "CIGNA PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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