Provider Demographics
NPI:1801178868
Name:BAEK, EUGENE OM (PT)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:OM
Last Name:BAEK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CRYSTAL HILL DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2603
Mailing Address - Country:US
Mailing Address - Phone:973-478-2212
Mailing Address - Fax:
Practice Address - Street 1:224 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6411
Practice Address - Country:US
Practice Address - Phone:973-478-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00080600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist