1710620760 NPI number — AMIT BARUA MBBS

Table of content: AMIT BARUA MBBS (NPI 1710620760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710620760 NPI number — AMIT BARUA MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARUA
Provider First Name:
AMIT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
M

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:
1710620760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/13/2023
NPI Reactivation Date:
02/06/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 READE PLACE, VASSAR BROTHERS MEDICAL CENTER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-3990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-790-1314
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 ROBBINS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-568-2906
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2022

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 79773 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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