Provider Demographics
NPI:1689642704
Name:BAUER, JOEL J (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:J
Last Name:BAUER
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 1:25 EAST 69TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4925
Mailing Address - Country:US
Mailing Address - Phone:212-517-8600
Mailing Address - Fax:212-535-3717
Practice Address - Street 1:25 EAST 69TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4925
Practice Address - Country:US
Practice Address - Phone:212-517-8600
Practice Address - Fax:212-535-3717
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102125208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY973671Medicare PIN
B80256Medicare UPIN