1235198771 NPI number — BASSAM ALDAIA MD LLP

Table of content: (NPI 1235198771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235198771 NPI number — BASSAM ALDAIA MD LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASSAM ALDAIA MD LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235198771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 92ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11228-3621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-836-1598
Provider Business Mailing Address Fax Number:
718-836-7672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 92ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11228-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-836-1598
Provider Business Practice Location Address Fax Number:
718-836-7672
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALDAIA
Authorized Official First Name:
BASSAM
Authorized Official Middle Name:
NICOLA
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
718-836-1598

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  128836 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 421-3921 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: OP222 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00435706 . This is a "MAGNACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0201503 . This is a "GROUP HEALTH INCORP. (GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 128836 . This is a "NYS MEDICAL LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 354121 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4C1093 . This is a "ACS HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: V00454329 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00339717 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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