Healthcare Provider Details

I. General information

NPI: 1649359241
Provider Name (Legal Business Name): EMIL BALTHAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE # A-560
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVE # A-560
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-2300
  • Fax: 212-562-3486
Mailing address:
  • Phone: 212-562-2300
  • Fax: 212-562-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number098380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: