Basic Information
| Provider Information | |||||||||
| NPI: | 1154978195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAEZ | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | ALEXIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 WATERS PLACE | ||||||||
| Address2: | TOWER 1, SUITE 501 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184099444 | ||||||||
| FaxNumber: | 7184090236 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 WATERS PLACE | ||||||||
| Address2: | TOWER 1, SUITE 501 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184099444 | ||||||||
| FaxNumber: | 7184090236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2019 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 044505-01 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 044505-01 | 01 | NY | LICENSE | OTHER |