Provider Demographics
NPI:1578556437
Name:BARASCH, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BARASCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 STIRLING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5751
Mailing Address - Country:US
Mailing Address - Phone:908-755-5437
Mailing Address - Fax:908-755-6905
Practice Address - Street 1:76 STIRLING RD
Practice Address - Street 2:STE 201
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5751
Practice Address - Country:US
Practice Address - Phone:908-755-5437
Practice Address - Fax:908-755-6905
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06097800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00019972OtherHIGH MARK PA BLUE SHIELD
NJ010060978NJ01OtherMULTIPLAN PIN
NJ1K3073OtherHEALTH NET PIN
NJ78J801OtherEMPIRE PIN
NJ503377OtherAETNA HMO PIN
NJTP088OtherOXFORD PIN
NJ0725154000OtherAMERIHEALTH HMO PIN
NJ199972OtherAMERIHEALTH PPO PIN
NJ2468321006OtherCIGNA PIN