Doctor Name: | DR. JACK LAWRENCE BALDASSARE |
NPI Number: | 1225070121 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 124001-1 |
Business Practice Address: | 220 Oxford Dr Tenafly, NJ - 076703118 |
Business Phone Number: | 2015676156 |
Business Fax Number: | 2018718708 |
Mailing Address: | 220 Oxford Dr, TENAFLY |
State: | NJ |
Postal Code: | 076703118 |
Phone Number: | 2015676156 |
Fax Number: | 2018718708 |
NPI Enumeration Date: | 06/12/2006 |
NPI Last Update Date: | 12/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | 124001-1 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |