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NPI Code Detail

MEDICARE: MOONJU BAE

MEDICARE: MOONJU BAE
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
1363LF0000XFamily Nurse PractitionerF343116NY

General Provider Information

NPI Number : 1912484627
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOONJU BAE
Provider Business Mailing Address
First Line : 2213 CITY PL
Second Line :
City : EDGEWATER
State : NJ
Zip : 07020-3155
Country : US
Telephone Number : 718-618-0401
Fax Number : 607-306-4582
Provider Business Practice Location Address
First Line : 3750 72ND ST
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-6143
Country : US
Telephone Number : 844-692-4692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2018
Last Update Date : 02/18/2026

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Directions to “ MOONJU BAE ” Practice Location

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