Provider Demographics
NPI:1376694786
Name:BAUM, MICHAEL JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:BAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:PROF
Other - First Name:DOCTORS CARE ASSOCIA
Other - Middle Name:
Other - Last Name:L.L.C.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:908 OAK TREE AVE STE L
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5100
Mailing Address - Country:US
Mailing Address - Phone:908-757-6660
Mailing Address - Fax:908-757-5332
Practice Address - Street 1:908 OAK TREE AVE STE L
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5100
Practice Address - Country:US
Practice Address - Phone:908-757-6660
Practice Address - Fax:908-757-5332
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04528600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB04528600OtherLICENSE
NJ25MB04528600OtherLICENSE
NJ451830Medicare ID - Type UnspecifiedMEDICARE