Provider Demographics
NPI:1902867971
Name:BAKER, JEANNEMARIE G (NP-P)
Entity Type:Individual
Prefix:
First Name:JEANNEMARIE
Middle Name:G
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP-P
Other - Prefix:
Other - First Name:JEANNEMARIE
Other - Middle Name:
Other - Last Name:GELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2 HIGHGATE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-2611
Mailing Address - Country:US
Mailing Address - Phone:203-637-1399
Mailing Address - Fax:
Practice Address - Street 1:ST. PAUL'S CENTER
Practice Address - Street 2:424 WEST 34TH ST.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2321
Practice Address - Country:US
Practice Address - Phone:212-695-3444
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400237363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02499223Medicaid
NY91V621Medicare ID - Type Unspecified
NYS45048Medicare UPIN