1437629433 NPI number — CRAIG BALDENHOFER MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437629433 NPI number — CRAIG BALDENHOFER MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG BALDENHOFER MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1437629433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
338 BERRY ST APT 6A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11249-5250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-774-0071
Provider Business Mailing Address Fax Number:
212-255-9801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 W 27TH ST FL 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-255-9800
Provider Business Practice Location Address Fax Number:
212-255-9801
Provider Enumeration Date:
12/03/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BALDENHOFER
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-255-9800

Provider Taxonomy Codes

  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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