=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255516696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAKER MALDONADO EDNA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2008
-----------------------------------------------------
Last Update Date | 10/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 686 STONELEIGH AVE
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-279-1111
-----------------------------------------------------
Fax | 845-225-3805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 686 STONELEIGH AVE
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-279-1111
-----------------------------------------------------
Fax | 845-225-3805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PROVIDER
-----------------------------------------------------
Name | MS. EDNA D MALDONADO-BAKER
-----------------------------------------------------
Credential | OTR CHT
-----------------------------------------------------
Telephone | 845-279-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 006402-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------