Provider Demographics
NPI:1801871306
Name:LOSASSO, BARRY E (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:E
Last Name:LOSASSO
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 1:30 W CENTURY RD STE 235
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1421
Mailing Address - Country:US
Mailing Address - Phone:201-225-9440
Mailing Address - Fax:848-235-7174
Practice Address - Street 1:30 W CENTURY RD STE 235
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1421
Practice Address - Country:US
Practice Address - Phone:201-225-9440
Practice Address - Fax:848-235-7174
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41471174400000X
NJ25MA97796002086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222615577OtherPROVIDER TAX ID
CA33-0642904OtherPROVIDER TAX ID
CA00G414710Medicaid