Provider Demographics
NPI:1205910999
Name:BAE, STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:
Last Name:BAE
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 1:3122 UNION ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2338
Mailing Address - Country:US
Mailing Address - Phone:718-353-9338
Mailing Address - Fax:718-353-9327
Practice Address - Street 1:3122 UNION ST APT 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2338
Practice Address - Country:US
Practice Address - Phone:718-353-9338
Practice Address - Fax:718-353-9327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183407207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7250980OtherCIGNA
NY172435OtherELDER PLAN
NY845061OtherEMPIRE BCBS
NY2289736OtherAETNA SPECIALIST
NY3300115OtherGHI & COMP BEN ADMIN
NY3C2745OtherNYNM
NYQS0000806OtherCBCA ADMIN SELECT PRO
NY01623647Medicaid
NY3C9031OtherHEALTH NET
NY5500012OtherVYTRA
NY5725414OtherAETNA PPO MANAGED CARE
NY610965200OtherUS DEPT OF LABOR
NY168086OtherAFFINITY
NYP384913OtherOXFORD
NY5725414OtherAETNA PPO MANAGED CARE