Provider Demographics
NPI:1619798543
Name:BARSOUM, ANNMARIE (OD)
Entity type:Individual
Prefix:DR
First Name:ANNMARIE
Middle Name:
Last Name:BARSOUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KINDERKAMACK RD UNIT 683
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4880
Mailing Address - Country:US
Mailing Address - Phone:973-856-1768
Mailing Address - Fax:
Practice Address - Street 1:23 HOWE AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4001
Practice Address - Country:US
Practice Address - Phone:973-777-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00200100125Q00000X
NJ27OA00732600152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No125Q00000XDental ProvidersDentistOral Medicine