Provider Demographics
NPI:1962029272
Name:BAKER, MAZHAR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MAZHAR
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3945
Mailing Address - Country:US
Mailing Address - Phone:516-318-3185
Mailing Address - Fax:
Practice Address - Street 1:101 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-318-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant