Baldassare, Jack Lawrence
Baldassare, Jack Lawrence is an individual health care provider with primary practice located at 220 Oxford Dr , Tenafly NJ 07670-3118. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Baldassare, Jack Lawrence can be contacted via phone (201) 567-6156.Contact Information
Primary practice address
220 Oxford Dr
Tenafly NJ 07670-3118
Phone: (201) 567-6156
Fax: (201) 871-8708
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 25MA3606000 | New Jersey |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 124001-1 | New York |
Profile Details
| NPI number | 1225070121 |
|---|---|
| LBN Legal business name | Baldassare, Jack Lawrence |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2006 |
| Last updated | Dec 15th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225070121 | NPPES |
| New York | MEDICAID | 00481521 | |
| New York | Other | BA113644 | |
| New York | MEDICAID | 0864307 |
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