Healthcare Provider Details

I. General information

NPI: 1568510311
Provider Name (Legal Business Name): BLANCA PERLA BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

1 CHADWICK CT
PARK RIDGE NJ
07656-2155
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5000
  • Fax: 718-579-4822
Mailing address:
  • Phone: 201-391-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number25MA08532900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: