Provider Demographics
NPI:1083983506
Name:REBECCA BAXT, M.D., PC
Entity type:Organization
Organization Name:REBECCA BAXT, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-265-1300
Mailing Address - Street 1:651 EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2901
Mailing Address - Country:US
Mailing Address - Phone:201-265-1300
Mailing Address - Fax:201-265-3737
Practice Address - Street 1:635 MADISON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:212-753-6033
Practice Address - Fax:212-308-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06657800207N00000X
NY213269-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty