Provider Demographics
NPI:1689124976
Name:BAEZ, HIPOLITO
Entity Type:Individual
Prefix:
First Name:HIPOLITO
Middle Name:
Last Name:BAEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 BOSTON RD
Mailing Address - Street 2:4E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2240
Mailing Address - Country:US
Mailing Address - Phone:917-915-0256
Mailing Address - Fax:
Practice Address - Street 1:2123 BOSTON RD
Practice Address - Street 2:4E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2240
Practice Address - Country:US
Practice Address - Phone:917-915-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage