Healthcare Provider Details

I. General information

NPI: 1164345989
Provider Name (Legal Business Name): PEDRO A BAEZ MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 VERLY CT
BETHPAGE NY
11714-5913
US

IV. Provider business mailing address

5 VERLY CT
BETHPAGE NY
11714-5913
US

V. Phone/Fax

Practice location:
  • Phone: 917-723-3385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO A BAEZ
Title or Position: MD
Credential: MD
Phone: 917-723-3385