Provider Demographics
NPI:1699770586
Name:BARON, EDWARD M (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:BARON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:375 E MAIN ST
Mailing Address - Street 2:STE 24
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8418
Mailing Address - Country:US
Mailing Address - Phone:516-872-8309
Mailing Address - Fax:516-872-8727
Practice Address - Street 1:65 ROOSEVELT AVE
Practice Address - Street 2:STE 204
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1106
Practice Address - Country:US
Practice Address - Phone:516-374-4199
Practice Address - Fax:516-295-5303
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-05-30
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Provider Licenses
StateLicense IDTaxonomies
NY162404207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01128436Medicaid
NYE20394Medicare UPIN
NY21F061Medicare ID - Type Unspecified