Healthcare Provider Details

I. General information

NPI: 1629369749
Provider Name (Legal Business Name): ALISSA BAKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 05/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE FL 3
BRONX NY
10467-2403
US

IV. Provider business mailing address

3411 WAYNE AVE FL 9
BRONX NY
10467-2552
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2342
  • Fax: 718-920-6506
Mailing address:
  • Phone: 718-741-2342
  • Fax: 718-920-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number296252
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number296252
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: