Provider Demographics
NPI:1497388870
Name:BAEK, JIHYE EUNICE (RN)
Entity Type:Individual
Prefix:
First Name:JIHYE
Middle Name:EUNICE
Last Name:BAEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 SPRUCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3838
Mailing Address - Country:US
Mailing Address - Phone:516-225-9528
Mailing Address - Fax:
Practice Address - Street 1:184 SPRUCEWOOD DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3838
Practice Address - Country:US
Practice Address - Phone:516-225-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY786767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse