Provider Demographics
NPI:1992753974
Name:BALDOMERO, ROY EBAJAY (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:EBAJAY
Last Name:BALDOMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LYONS AVE
Mailing Address - Street 2:DEPT OBGYN
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1720
Mailing Address - Country:US
Mailing Address - Phone:973-560-5198
Mailing Address - Fax:973-705-8650
Practice Address - Street 1:210 LYONS AVE
Practice Address - Street 2:DEPT OBGYN
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-1720
Practice Address - Country:US
Practice Address - Phone:973-560-5198
Practice Address - Fax:973-705-8650
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04001100207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine