Provider Demographics
NPI:1659663862
Name:PHILIP R BALDEO MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:PHILIP R BALDEO MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALDEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-845-8900
Mailing Address - Street 1:12507 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2233
Mailing Address - Country:US
Mailing Address - Phone:718-845-8900
Mailing Address - Fax:
Practice Address - Street 1:12511 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2233
Practice Address - Country:US
Practice Address - Phone:718-845-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty