MEDICARE: BAKER BREAST PROSTHESIS & SURGICAL STOCKINGS CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120423	OTHER	NY	AETNA
2	G71532	OTHER	NY	BLUE CROSS BLUE SHIELD
3	57C0601	OTHER	NY	COMMUNITY PREMIER PLUS
4	040401001486	OTHER	NY	FIDELIS CARE OF NY
5	1000002744	OTHER	NY	AFFINITY HEALTH PLAN
6	2C3110	OTHER	NY	HEALTHNET
7	57P0471	OTHER	NY	COMMUNITY HEALTH PLAN
8	A395883	OTHER	NY	OXFORD
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	174138	OTHER	NY	ELDERPLAN
11	1068780	OTHER	NY	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1144269911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKER BREAST PROSTHESIS & SURGICAL STOCKINGS CORP.

Provider Business Mailing Address
First Line	:	145 W 71ST ST
Second Line	:	SUITE 1F
City	:	NEW YORK
State	:	NY
Zip	:	10023-3802
Country	:	US
Telephone Number	:	212-877-8860
Fax Number	:	212-799-8356

Provider Business Practice Location Address
First Line	:	145 W 71ST ST
Second Line	:	SUITE 1F
City	:	NEW YORK
State	:	NY
Zip	:	10023-3802
Country	:	US
Telephone Number	:	212-877-8860
Fax Number	:	212-799-8356

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. ETTY ELBAUM
Credential	:
Telephone Number	:	212-877-8860

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/22/2020

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Directions to “BAKER BREAST PROSTHESIS & SURGICAL STOCKINGS CORP. ” Practice Location

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