Individual
MR. DUSTIN LEE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016-6402
(646) 369-7838
Mailing address
PO BOX 709, GREAT RIVER, NY 11739-0709
(631) 241-6694
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
016550
NY
363AM0700X
Medical Physician Assistant
Primary
016550
NY
363AS0400X
Surgical Physician Assistant
16550
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03739613
—
NY
Enumeration date
08/28/2013
Last updated
05/23/2024
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