Provider Demographics
NPI:1538408075
Name:JULISSA BAEZ MD PC
Entity type:Organization
Organization Name:JULISSA BAEZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-524-6351
Mailing Address - Street 1:232 E 12TH ST
Mailing Address - Street 2:UNIT 1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9151
Mailing Address - Country:US
Mailing Address - Phone:646-524-6351
Mailing Address - Fax:646-524-6362
Practice Address - Street 1:232 E 12TH ST
Practice Address - Street 2:UNIT 1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9151
Practice Address - Country:US
Practice Address - Phone:646-524-6351
Practice Address - Fax:646-524-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02797648Medicaid