MEDICARE: HIPOLITO BAEZ

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	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1689124976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIPOLITO BAEZ

Provider Business Mailing Address
First Line	:	2123 BOSTON RD
Second Line	:	4E
City	:	BRONX
State	:	NY
Zip	:	10460-2240
Country	:	US
Telephone Number	:	917-915-0256
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 BOSTON RD
Second Line	:	4E
City	:	BRONX
State	:	NY
Zip	:	10460-2240
Country	:	US
Telephone Number	:	917-915-0256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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Directions to “ HIPOLITO BAEZ ” Practice Location

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