Provider Demographics
NPI:1073797841
Name:CEDARZ MEDICAL AND COSMEDICS,INC.
Entity Type:Organization
Organization Name:CEDARZ MEDICAL AND COSMEDICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BAAKLINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-253-0025
Mailing Address - Street 1:812 METACOM AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809
Mailing Address - Country:US
Mailing Address - Phone:401-253-0025
Mailing Address - Fax:
Practice Address - Street 1:812 METACOM AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-5160
Practice Address - Country:US
Practice Address - Phone:401-253-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7640207RP1001X
RI9894207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBM35884Medicaid