Provider Demographics
NPI:1457613424
Name:BARI, RAISA (MED)
Entity Type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:BARI
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 35TH AVE
Mailing Address - Street 2:APT# 517W
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-8197
Mailing Address - Country:US
Mailing Address - Phone:615-720-1359
Mailing Address - Fax:
Practice Address - Street 1:7410 35TH AVE
Practice Address - Street 2:APT# 517W
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8197
Practice Address - Country:US
Practice Address - Phone:615-720-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist