Provider Demographics
NPI:1427873595
Name:BAILLARD, ROY V
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:V
Last Name:BAILLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2646
Mailing Address - Country:US
Mailing Address - Phone:631-849-1620
Mailing Address - Fax:631-849-1587
Practice Address - Street 1:595 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2646
Practice Address - Country:US
Practice Address - Phone:631-849-1620
Practice Address - Fax:631-849-1587
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027913-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist