Provider Demographics
NPI:1093863508
Name:BAQUIRAN, HENRY M (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:M
Last Name:BAQUIRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:179 CAHILL CROSS RD STE 314
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1988
Mailing Address - Country:US
Mailing Address - Phone:973-728-1880
Mailing Address - Fax:973-728-1559
Practice Address - Street 1:179 CAHILL CROSS RD STE 314
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1988
Practice Address - Country:US
Practice Address - Phone:973-728-1880
Practice Address - Fax:973-728-1559
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ42953001208D00000X
NJ25MA04295300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE62054Medicare UPIN