Provider Demographics
NPI:1356408645
Name:BARISO, CESAR (MD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:BARISO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9211 35TH AVE
Mailing Address - Street 2:1E
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5866
Mailing Address - Country:US
Mailing Address - Phone:718-217-2896
Mailing Address - Fax:718-217-4471
Practice Address - Street 1:9211 35TH AVE
Practice Address - Street 2:1E
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5866
Practice Address - Country:US
Practice Address - Phone:718-217-2896
Practice Address - Fax:718-217-4471
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY109807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78481Medicare UPIN