=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982978326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSE A BAEZ MD PC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2012
-----------------------------------------------------
Last Update Date | 03/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 W 171ST ST STE W
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-927-4765
-----------------------------------------------------
Fax | 212-927-4765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 SAINT JOHNS AVE
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10704-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-927-4765
-----------------------------------------------------
Fax | 212-927-4857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. ANANIA PENA-BAEZ
-----------------------------------------------------
Credential | NURSE
-----------------------------------------------------
Telephone | 212-927-4765
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 197338
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------