Provider Demographics
NPI:1679133060
Name:BAPTISTE, EDWARD E JR (LMT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:BAPTISTE
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21622 121ST AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1932
Mailing Address - Country:US
Mailing Address - Phone:929-253-9158
Mailing Address - Fax:
Practice Address - Street 1:21622 121ST AVE FL 2
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1932
Practice Address - Country:US
Practice Address - Phone:929-253-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist