Provider Demographics
NPI:1861512485
Name:BALDASARE, JANET LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNNE
Last Name:BALDASARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2066
Mailing Address - Country:US
Mailing Address - Phone:631-727-1818
Mailing Address - Fax:631-727-7365
Practice Address - Street 1:1190 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2066
Practice Address - Country:US
Practice Address - Phone:631-727-1818
Practice Address - Fax:631-727-7365
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301521363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health