Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA03700400 | NJ |
NPI | 1174586341 |
---|---|
Provider Name | Raja Barakat |
First Address | Holmdel, NJ 07733-1528 |
Second Address | Holmdel, NJ 07733-1528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 22/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
315501 | (05) | NJ |
F07194 | (02) | NJ |