Provider Demographics
NPI:1467566299
Name:BAEZ, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:BAEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:E
Other - Last Name:BAEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:19 BAKER AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-483-5888
Mailing Address - Fax:845-471-4381
Practice Address - Street 1:19 BAKER AVE
Practice Address - Street 2:STE 302
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-483-5888
Practice Address - Fax:845-471-4381
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159629207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01147502Medicaid
A63154Medicare UPIN
NY01147502Medicaid