Healthcare Provider Details

I. General information

NPI: 1295710291
Provider Name (Legal Business Name): NEAL ARTHUR BAILLARGEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ELM STREET
PHILMONT NY
12565
US

IV. Provider business mailing address

PO BOX 766 90 BROAD ST
KINDERHOOK NY
12106-0766
US

V. Phone/Fax

Practice location:
  • Phone: 518-672-5401
  • Fax: 518-672-5403
Mailing address:
  • Phone: 518-758-7252
  • Fax: 518-758-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number161495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: