Provider Demographics
NPI:1609045046
Name:JEAN-BAPTISTE, EDDY S (NURSING CARE,RN)
Entity Type:Individual
Prefix:MR
First Name:EDDY
Middle Name:S
Last Name:JEAN-BAPTISTE
Suffix:
Gender:M
Credentials:NURSING CARE,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 KITTY HAWK DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1620
Mailing Address - Country:US
Mailing Address - Phone:585-381-7852
Mailing Address - Fax:
Practice Address - Street 1:19 KITTY HAWK DR
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1620
Practice Address - Country:US
Practice Address - Phone:585-381-7852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285771-1164W00000X
NY641225163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNPI: 1609045046Medicaid