Individual
DR. JACK LAWRENCE BALDASSARE
Active
Individual
DR. JACK LAWRENCE BALDASSARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
124001-1
NY
2085R0202X
Diagnostic Radiology Physician
Primary
25MA3606000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00481521
—
NY
05
—
0864307
—
NJ
01
—
BA113644
MEDICARE ID-TYPE
NJ
Enumeration date
06/12/2006
Last updated
12/15/2009
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