Provider Demographics
NPI:1013149038
Name:RAFFI BARSOUMIAN MD
Entity Type:Organization
Organization Name:RAFFI BARSOUMIAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RESTIVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-794-4161
Mailing Address - Street 1:20 DEVINE AVE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3721
Mailing Address - Country:US
Mailing Address - Phone:516-287-1120
Mailing Address - Fax:516-794-9568
Practice Address - Street 1:20 DEVINE AVE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3721
Practice Address - Country:US
Practice Address - Phone:516-287-1120
Practice Address - Fax:516-794-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240858208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02935702Medicaid
NY08324NMedicare PIN
NY632H31Medicare PIN