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General NPI Number Information
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NPI Number | 1801286679
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Entity Type | Organization
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Legal Business Name | BAXTER MEDICAL CARE PC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 17121 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-5427
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Country | US
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Telephone | 718-521-4442
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Fax | 718-305-4568
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Provider Business Mailing Address
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Address Line | 13130A MERRICK BLVD
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City | JAMAICA
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State | NY
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Zip | 11434-4134
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Country | US
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Telephone | 718-233-2556
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Fax | 718-233-2569
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADDY NNSEWO
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Credential | MD
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Telephone | 516-236-0336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 234005
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License Number State | NY
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