Joel Oliver Baxter I, REGISTERED NURSE

Individual provider Active NPI Nursing Home Administrator · Sunnyside, NY

NPI 1669822375 · NPPES record last updated Jun 14, 2016

Key facts

NPI
1669822375
Entity type
Individual (NPI type 1)
Primary specialty
Nursing Home Administrator 376G00000X
License
706250 (NY)
Practice address
4556 42ND St Apt 4D
Sunnyside, NY 11104-2949
Phone
(929) 225-9342
NPI assigned
Jun 14, 2016
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
706250NYMDNursing Home Administrator

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Home Administrator 376G00000X 706250 NY Yes

Addresses

Primary practice location

4556 42ND St Apt 4D
Sunnyside, NY 11104-2949

Mailing address

4556 42ND St Apt 4D
Sunnyside, NY 11104-2949
Phone (929) 225-9342

Other providers in Sunnyside, NY

All providers in Sunnyside, NY · Nursing Home Administrator in New York

Sources for this page

Verify at the official NPI Registry.