Provider Demographics
NPI:1679592083
Name:BAUM, JOEL ASHER (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ASHER
Last Name:BAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11203 QUEENS BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7473
Mailing Address - Country:US
Mailing Address - Phone:718-897-0516
Mailing Address - Fax:718-897-0590
Practice Address - Street 1:11203 QUEENS BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7473
Practice Address - Country:US
Practice Address - Phone:718-897-0516
Practice Address - Fax:718-897-0590
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY177455207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01391868Medicaid
NY01391868Medicaid
NY34485Medicare ID - Type Unspecified
NY02711CMedicare PIN