Healthcare Provider Details

I. General information

NPI: 1255661211
Provider Name (Legal Business Name): GERARD ANTHONY BALTAZAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD
GREENWICH CT
06830-4608
US

IV. Provider business mailing address

600 MAMARONECK AVE STE 400
HARRISON NY
10528-1613
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3000
  • Fax:
Mailing address:
  • Phone: 914-274-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number255827
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number255827
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number255827
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number255827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: