Provider Demographics
NPI:1346234630
Name:BACCAY, FRANCIS BALOLONG (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:BALOLONG
Last Name:BACCAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3050N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-372-7196
Mailing Address - Fax:
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE3050N
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-347-0162
Practice Address - Fax:914-347-4401
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223189208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02200342Medicaid
NY22R9794181Medicare PIN
NY22R971Medicare PIN
NY02200342Medicaid
NYA400053551Medicare PIN