1902915176 NPI number — DR. BELINDA BASACA M.D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902915176 NPI number — DR. BELINDA BASACA M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASACA
Provider First Name:
BELINDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1902915176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
86 FOREST AVE. 2ND FLOOR
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
GLEN COVE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-759-0900
Provider Business Mailing Address Fax Number:
519-759-0195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 FOREST AVE.
Provider Second Line Business Practice Location Address:
2ND FLOOR SUITE D
Provider Business Practice Location Address City Name:
GLEN COVE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-759-0900
Provider Business Practice Location Address Fax Number:
519-759-0195
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  BB8479835 , 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: 02585748 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02585748 . This is a "CHILD HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02585748 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02585748 . This is a "CHOISE CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02585748 . This is a "EMPIRE BS/BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02585748 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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