Healthcare Provider Details

I. General information

NPI: 1023063245
Provider Name (Legal Business Name): WILLIAM BAKEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SHOPRITE BLVD
ELLENVILLE NY
12428-5632
US

IV. Provider business mailing address

279 MAIN ST SUITE 204
NEW PALTZ NY
12561-1623
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-4500
  • Fax: 845-647-7632
Mailing address:
  • Phone: 845-255-3046
  • Fax: 845-255-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: