Provider Demographics
NPI:1366412413
Name:BAKER, JOHN G (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:160 FARBER HALL
Mailing Address - Street 2:UNIVERSITY AT BUFFALO
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-829-5500
Mailing Address - Fax:716-829-2138
Practice Address - Street 1:37 S CAYUGA RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6705
Practice Address - Country:US
Practice Address - Phone:716-626-7492
Practice Address - Fax:716-626-4496
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY010677103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0768Medicare ID - Type Unspecified