Healthcare Provider Details

I. General information

NPI: 1366412413
Provider Name (Legal Business Name): JOHN G BAKER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 S CAYUGA RD
WILLIAMSVILLE NY
14221-6705
US

IV. Provider business mailing address

160 FARBER HALL UNIVERSITY AT BUFFALO
BUFFALO NY
14214
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-7492
  • Fax: 716-626-4496
Mailing address:
  • Phone: 716-829-5500
  • Fax: 716-829-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number010677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: