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NPI Code Detail

MEDICARE: MICHELE BALTUS MD

MEDICARE: MICHELE BALTUS MD
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
1207Q00000XFamily Medicine Physician197626-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700883899
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE BALTUS MD
Provider Business Mailing Address
First Line : 180 E PULASKI RD
Second Line :
City : HUNTINGTON STATION
State : NY
Zip : 11746-1915
Country : US
Telephone Number : 631-425-2121
Fax Number : 631-425-2193
Provider Business Practice Location Address
First Line : 180 E PULASKI RD
Second Line :
City : HUNTINGTON STATION
State : NY
Zip : 11746-1915
Country : US
Telephone Number : 631-425-2121
Fax Number : 631-425-2193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 02/23/2021

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Directions to “ MICHELE BALTUS MD” Practice Location

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