Provider Demographics
NPI:1891837209
Name:SAIDABAXTMDPA
Entity Type:Organization
Organization Name:SAIDABAXTMDPA
Other - Org Name:BAXTCOSMEDICALCOSMEDICALNJ
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-265-1300
Mailing Address - Street 1:351 EVELYN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2901
Mailing Address - Country:US
Mailing Address - Phone:201-265-1300
Mailing Address - Fax:201-265-3737
Practice Address - Street 1:351 EVELYN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2901
Practice Address - Country:US
Practice Address - Phone:201-265-1300
Practice Address - Fax:201-265-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ031490Medicare UPIN
NJ081207Medicare UPIN