Provider Demographics
NPI:1841390341
Name:BAKER, DONALD J (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:BAKER
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 1:20 RENWICK HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2144
Mailing Address - Country:US
Mailing Address - Phone:607-279-7708
Mailing Address - Fax:
Practice Address - Street 1:3 CENTURY DR
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4610
Practice Address - Country:US
Practice Address - Phone:973-740-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223802-1207P00000X
NY223802207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
851371OtherABEM
NY02259992Medicaid
NY223802OtherSTATE LICENSE
NY223802OtherSTATE LICENSE
851371OtherABEM
NYDD1020Medicare ID - Type Unspecified
NYAB2333350OtherDEA
DD1020Medicare ID - Type Unspecified