Provider Demographics
NPI:1750417283
Name:BAX, JOSEPH ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:BAX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 EILEEN WAY
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5302
Mailing Address - Country:US
Mailing Address - Phone:516-496-4964
Mailing Address - Fax:516-496-4950
Practice Address - Street 1:121 EILEEN WAY
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-5302
Practice Address - Country:US
Practice Address - Phone:516-496-4964
Practice Address - Fax:516-496-4950
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11361208VP0014X, 208100000X, 2081P2900X
NY261427208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation