Provider Demographics
NPI:1609849454
Name:BABAN, EUGENIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIO
Middle Name:A
Last Name:BABAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EUGENIO
Other - Middle Name:AR
Other - Last Name:BABAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11702 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2012
Mailing Address - Country:US
Mailing Address - Phone:718-634-2606
Mailing Address - Fax:718-634-4957
Practice Address - Street 1:11702 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2012
Practice Address - Country:US
Practice Address - Phone:718-634-2606
Practice Address - Fax:718-634-4957
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105765207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB16766Medicare UPIN
NY57949Medicare ID - Type Unspecified