Provider Demographics
NPI:1083930325
Name:BAEZ, ALEX (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BAEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3557
Mailing Address - Country:US
Mailing Address - Phone:631-424-1100
Mailing Address - Fax:631-424-1105
Practice Address - Street 1:467 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3557
Practice Address - Country:US
Practice Address - Phone:631-424-1100
Practice Address - Fax:631-424-1105
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032394-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist