Healthcare Provider Details

I. General information

NPI: 1801976469
Provider Name (Legal Business Name): SYDNEY T BAKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 SIXTH STREET NEW YORK METHODIST HOSPITAL
BROOKLYN NY
11215-9008
US

IV. Provider business mailing address

655 MACON ST
BROOKLYN NY
11233-1517
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5942
  • Fax:
Mailing address:
  • Phone: 347-350-8581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: