Provider Demographics
NPI:1326114646
Name:BAKER, ELLEN P (AUD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:P
Last Name:BAKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5122
Mailing Address - Country:US
Mailing Address - Phone:718-338-1736
Mailing Address - Fax:718-252-5666
Practice Address - Street 1:1503 E 22ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5122
Practice Address - Country:US
Practice Address - Phone:718-338-1736
Practice Address - Fax:718-252-5666
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00-1313231H00000X
NY00-1312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S02683Medicare UPIN
NYM17751Medicare ID - Type Unspecified