Provider Demographics
NPI:1033110960
Name:BAUMGARTEN, STEPHEN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:BAUMGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OCEAN AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3149
Mailing Address - Country:US
Mailing Address - Phone:718-382-8777
Mailing Address - Fax:718-228-8362
Practice Address - Street 1:2301 OCEAN AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3149
Practice Address - Country:US
Practice Address - Phone:718-382-8777
Practice Address - Fax:718-228-8362
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109278208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00258186Medicaid
NYB12660Medicare UPIN
NY308701Medicare ID - Type Unspecified