Provider Demographics
NPI:1750525432
Name:BARSOOM, RAAFAT (MD)
Entity type:Individual
Prefix:
First Name:RAAFAT
Middle Name:
Last Name:BARSOOM
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 1:9 APPLETREE DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3477
Mailing Address - Country:US
Mailing Address - Phone:973-202-2783
Mailing Address - Fax:
Practice Address - Street 1:617 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4403
Practice Address - Country:US
Practice Address - Phone:862-246-7940
Practice Address - Fax:862-246-7940
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08647900207P00000X
NV22055207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0242179Medicaid
NY03280802Medicaid