Provider Demographics
NPI:1578697447
Name:BAKER, RUKAIYA ALIASGER (PT)
Entity Type:Individual
Prefix:MRS
First Name:RUKAIYA
Middle Name:ALIASGER
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RUKAIYA
Other - Middle Name:IDRIS
Other - Last Name:DAHODWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208-09 UNION TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364
Mailing Address - Country:US
Mailing Address - Phone:317-388-0800
Mailing Address - Fax:317-388-0805
Practice Address - Street 1:208-09 UNION TURNPIKE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364
Practice Address - Country:US
Practice Address - Phone:718-479-6370
Practice Address - Fax:718-464-0954
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028360171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400024048Medicare UPIN