Provider Demographics
NPI:1295192482
Name:BAUM, JAY BENJAMIN (LPN)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:BENJAMIN
Last Name:BAUM
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 BURDETT AVE
Mailing Address - Street 2:BHOP 2ND FLR SAMARITAN HOSPITAL
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2466
Mailing Address - Country:US
Mailing Address - Phone:518-271-3731
Mailing Address - Fax:518-271-3732
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:BHOP 2ND FLR SAMARITAN HOSPITAL
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3731
Practice Address - Fax:518-271-3732
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321509-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse