Provider Demographics
NPI:1043610090
Name:RICHMOND MEDICAL CARE PC
Entity Type:Organization
Organization Name:RICHMOND MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN - PIERRE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARAKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-399-1079
Mailing Address - Street 1:1655 RICHMOND AVE
Mailing Address - Street 2:STE B102
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1582
Mailing Address - Country:US
Mailing Address - Phone:718-682-1092
Mailing Address - Fax:718-682-1093
Practice Address - Street 1:1655 RICHMOND AVE
Practice Address - Street 2:STE B102
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1582
Practice Address - Country:US
Practice Address - Phone:718-682-1092
Practice Address - Fax:718-682-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03055823Medicaid