Doctor Name: | JENNESE BAKER |
NPI Number: | 1124275631 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 008661 |
Business Practice Address: | 21604 Union Tpke Oakland Gardens, NY - 113643525 |
Business Phone Number: | 7184653200 |
Business Fax Number: | 7184659792 |
Mailing Address: | 21604 Union Tpke, OAKLAND GARDENS |
State: | NY |
Postal Code: | 113643525 |
Phone Number: | 7184653200 |
Fax Number: | 7184659792 |
NPI Enumeration Date: | 08/26/2008 |
NPI Last Update Date: | 08/26/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 008661 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |