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General NPI Number Information
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NPI Number | 1922432723
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Entity Type | Individual
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Provider Name | DUSTIN LEE BAKER PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 550 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 646-369-7838
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 709
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City | GREAT RIVER
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State | NY
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Zip | 11739-0709
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Country | US
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Telephone | 631-241-6694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 016550
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 16550
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 016550
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License Number State | NY
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