Provider Demographics
NPI:1902877327
Name:BAIK, SEOUNG WON (MD)
Entity Type:Individual
Prefix:DR
First Name:SEOUNG
Middle Name:WON
Last Name:BAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:BAIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD1
Mailing Address - Street 1:1608 LEMOINE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5636
Mailing Address - Country:US
Mailing Address - Phone:201-302-9774
Mailing Address - Fax:732-744-1592
Practice Address - Street 1:1608 LEMOINE AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5636
Practice Address - Country:US
Practice Address - Phone:201-302-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43923174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3936406Medicaid
NJ521038MWWMedicare ID - Type Unspecified
NJ3936406Medicaid
NJ024865Medicare ID - Type UnspecifiedFORT LEE