Provider Demographics
NPI:1972977619
Name:STEWART BAE MEDICAL,PLLC
Entity type:Organization
Organization Name:STEWART BAE MEDICAL,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:H
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-353-9338
Mailing Address - Street 1:PO BOX 541195
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-7195
Mailing Address - Country:US
Mailing Address - Phone:718-353-9338
Mailing Address - Fax:718-353-9327
Practice Address - Street 1:3122 UNION ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2332
Practice Address - Country:US
Practice Address - Phone:718-353-9338
Practice Address - Fax:718-353-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183407207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty