1205910999 NPI number — DR. STEWART BAE M.D.

Table of content: DR. STEWART BAE M.D. (NPI 1205910999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205910999 NPI number — DR. STEWART BAE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAE
Provider First Name:
STEWART
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205910999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3122 UNION ST APT 1B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11354-2338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-353-9338
Provider Business Mailing Address Fax Number:
718-353-9327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3122 UNION ST APT 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-353-9338
Provider Business Practice Location Address Fax Number:
718-353-9327
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  183407 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 183407 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7250980 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 172435 . This is a "ELDER PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 845061 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2289736 . This is a "AETNA SPECIALIST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3300115 . This is a "GHI & COMP BEN ADMIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C2745 . This is a "NYNM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QS0000806 . This is a "CBCA ADMIN SELECT PRO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01623647 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3C9031 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5500012 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5725414 . This is a "AETNA PPO MANAGED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 610965200 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 168086 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P384913 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".