Healthcare Provider Details

I. General information

NPI: 1275027716
Provider Name (Legal Business Name): HANNAH AMELIA BAE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH AMELIA MYERS MD

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 04/19/2024
Certification Date: 08/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

622 W 168TH ST
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9197
  • Fax:
Mailing address:
  • Phone: 212-305-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number276183
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number321310
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number321310
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: