Provider Demographics
NPI:1922313907
Name:BARSOUM, EMAD ADLY FAKHOURY (MD)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:ADLY FAKHOURY
Last Name:BARSOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 PARK AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3253
Mailing Address - Country:US
Mailing Address - Phone:908-222-8970
Mailing Address - Fax:908-222-8762
Practice Address - Street 1:1314 PARK AVE STE 9
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3253
Practice Address - Country:US
Practice Address - Phone:908-222-8970
Practice Address - Fax:908-222-8762
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275918207R00000X, 208M00000X
NJ25MA10590000207RC0000X, 207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03921822Medicaid