Healthcare Provider Details

I. General information

NPI: 1740976661
Provider Name (Legal Business Name): JACK BAICHAO DING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. BAICHAO DING

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2985
  • Fax: 718-920-2058
Mailing address:
  • Phone: 718-920-2985
  • Fax: 718-920-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4007226UPD
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: