Provider Demographics
NPI:1437472263
Name:BARSOUM, NADER (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:NADER
Middle Name:
Last Name:BARSOUM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1434
Mailing Address - Country:US
Mailing Address - Phone:917-815-4917
Mailing Address - Fax:
Practice Address - Street 1:2474 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2136
Practice Address - Country:US
Practice Address - Phone:516-731-2483
Practice Address - Fax:516-735-1581
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1437472263Medicaid