Provider Demographics
NPI:1992077069
Name:BAKER, RYAN EDWARD (RPAC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:EDWARD
Last Name:BAKER
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EAST INDUSTRY COURT
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729
Mailing Address - Country:US
Mailing Address - Phone:631-667-0222
Mailing Address - Fax:631-667-0223
Practice Address - Street 1:60 E INDUSTRY CT
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4728
Practice Address - Country:US
Practice Address - Phone:631-667-0222
Practice Address - Fax:631-667-0223
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015345363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical