| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | BARAQUE IVAN DARIO MD · BARAQUE, IVAN DARIO | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| ID Number | 00161270 | [sources] | |||
| NPI | 1811059967 | [sources] | |||
| Sector | MD · Physician | [sources] | |||
| Status | not available | [sources] | |||
| Address | 4 WOODCREST COURT, WEST NYACK, NY 10994 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers deemed ineligible to participate in New York State's Medicaid program.
United States · OMIG
Medical providers disqualified from participating in New Jersey State's Medicaid program.
United States · OIFP
us-medny-3c34358927ed4b7476dea30fd1e99b804f8df965 · us-mednj-51d2c2944e32aea722a81dbde0d1a1f91529b0eaFor experts: raw data explorer
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States | New Jersey Office of the State Comptroller | - | |||
| Address | ||
|---|---|---|
| Full address | Country | |
| 4 WOODCREST COURT, WEST NYACK, NY 10994 | United States | |
| United States | New York State Office of the Medicaid Inspector General | - | - |