Provider Demographics
NPI:1902061146
Name:BARASCH, DAPHNA-RAQUEL (DO)
Entity Type:Individual
Prefix:
First Name:DAPHNA-RAQUEL
Middle Name:
Last Name:BARASCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LAVENDERS CT
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3923
Mailing Address - Country:US
Mailing Address - Phone:516-967-4745
Mailing Address - Fax:516-300-1127
Practice Address - Street 1:137 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2677
Practice Address - Country:US
Practice Address - Phone:516-750-8000
Practice Address - Fax:516-300-1127
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03040388Medicaid
NYA400160616Medicare PIN