Provider Demographics
NPI:1568403400
Name:DR PAUL BAUMGARTEN
Entity Type:Organization
Organization Name:DR PAUL BAUMGARTEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HORST
Authorized Official - Last Name:BAUMGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-346-6000
Mailing Address - Street 1:123 SARATOGA RD 2-1
Mailing Address - Street 2:THE FOOT DOCTOR
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302
Mailing Address - Country:US
Mailing Address - Phone:518-346-6000
Mailing Address - Fax:
Practice Address - Street 1:123 SARATOGA RD 2-1
Practice Address - Street 2:THE FOOT DOCTOR
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302
Practice Address - Country:US
Practice Address - Phone:518-346-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53551AMedicare PIN
NY0665360002Medicare NSC