Provider Demographics
NPI:1013973916
Name:BARUCHIN, MITCHELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:BARUCHIN
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 1:120 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2326
Mailing Address - Country:US
Mailing Address - Phone:201-216-9791
Mailing Address - Fax:201-216-1363
Practice Address - Street 1:120 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2326
Practice Address - Country:US
Practice Address - Phone:201-216-9791
Practice Address - Fax:201-216-1362
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05999700207UN0901X, 2085R0204X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5657601Medicaid
NJ060062410Medicare PIN
NJE94775Medicare UPIN
NJ484209Medicare PIN