Provider Demographics
NPI:1336368356
Name:BAEZ, KAREN (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2080
Mailing Address - Country:US
Mailing Address - Phone:718-448-8237
Mailing Address - Fax:
Practice Address - Street 1:800 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7034
Practice Address - Country:US
Practice Address - Phone:718-448-6800
Practice Address - Fax:718-448-9458
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078954-7174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist