Basic Information
| Provider Information | |||||||||
| NPI: | 1285875419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | MARGRET | ||||||||
| MiddleName: | ZAJAC | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CHURCH ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037523200 | ||||||||
| FaxNumber: | 2037529291 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 COMMERCE PARK | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064603511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033015401 | ||||||||
| FaxNumber: | 2038777165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2009 | ||||||||
| LastUpdateDate: | 03/18/2009 | ||||||||
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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 | 2251X0800X | 002095 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 11241174 | 01 | CT | CAQH | OTHER |