Provider Demographics
NPI:1659512002
Name:BADEN, MICHAEL MEYER (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MEYER
Last Name:BADEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 53RD ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5401
Mailing Address - Country:US
Mailing Address - Phone:212-397-2732
Mailing Address - Fax:212-397-2754
Practice Address - Street 1:15 W 53RD ST
Practice Address - Street 2:SUITE 18
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5401
Practice Address - Country:US
Practice Address - Phone:212-397-2732
Practice Address - Fax:212-397-2754
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085327-9174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6645305OtherREGISTRATION CERTIFICATE