Provider Demographics
NPI:1417913245
Name:BAXT, REBECCA D (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:BAXT
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 1:351 EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-265-1300
Mailing Address - Fax:201-265-3737
Practice Address - Street 1:351 EVELYN ST
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-265-1300
Practice Address - Fax:201-265-3737
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA66578207N00000X
NY2132691207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
O31490Medicare UPIN