Provider Demographics
NPI:1467945550
Name:BAKSI, DEVLEEN (DO)
Entity Type:Individual
Prefix:
First Name:DEVLEEN
Middle Name:
Last Name:BAKSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROWANSOM
Mailing Address - Street 2:18 E. LAUREL RD
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084
Mailing Address - Country:US
Mailing Address - Phone:856-346-7985
Mailing Address - Fax:
Practice Address - Street 1:94 OLD SHORT HILLS RD STE 1
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5668
Practice Address - Country:US
Practice Address - Phone:972-322-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11088400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty