Provider Demographics
NPI:1235272097
Name:BARON, JILL ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ROBIN
Last Name:BARON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 PARK AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0971
Mailing Address - Country:US
Mailing Address - Phone:646-472-5043
Mailing Address - Fax:646-224-6946
Practice Address - Street 1:1036 PARK AVE STE 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0971
Practice Address - Country:US
Practice Address - Phone:646-472-5043
Practice Address - Fax:646-224-6946
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171742-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE17271Medicare UPIN