Active NPI
Renee E Baskerville, MD
- Pediatric Adolescent Medicine Physician
- East Orange, NJ
National Provider Identifier
1376769372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- MA50489
- Practice address
- 90 Washington St
Suite 209
East Orange, NJ 07017 - Phone
- (973) 677-1551
- Fax
- (973) 509-2658
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | MA50489 | NJ | Primary |
Addresses
Primary practice location
90 Washington St
Suite 209
East Orange, NJ 07017
Mailing address
PO Box 141
Montclair, NJ 07042
Phone (973) 677-1551
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2016907 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA50489 | NJ | MD | Pediatric Adolescent Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376769372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 141",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "07042",
"telephone_number": "973-677-1551",
"fax_number": "973-509-2658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 WASHINGTON ST",
"address_2": "SUITE 209",
"city": "EAST ORANGE",
"state": "NJ",
"postal_code": "07017",
"telephone_number": "973-677-1551",
"fax_number": "973-509-2658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASKERVILLE",
"first_name": "RENEE",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "NJ",
"license": "MA50489",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2016907",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.