Healthcare Provider Details

I. General information

NPI: 1285114488
Provider Name (Legal Business Name): ALEXANDER BALDWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CHURCH ST
LAKE PLACID NY
12946-1805
US

IV. Provider business mailing address

73 RAWLINSON RD
ROCHESTER NY
14617-4607
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-8580
  • Fax:
Mailing address:
  • Phone: 585-506-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number043323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: