MEDICARE: OMAR BASHAYAN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	265495	NY

General Provider Information

NPI Number	:	1093058273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR BASHAYAN M.D

Provider Business Mailing Address
First Line	:	155 W 68TH ST
Second Line	:	APARTMENT 1102
City	:	NEW YORK
State	:	NY
Zip	:	10023-5808
Country	:	US
Telephone Number	:	917-374-2944
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 W 86TH ST
Second Line	:	SUITE 1B
City	:	NEW YORK
State	:	NY
Zip	:	10024-3605
Country	:	US
Telephone Number	:	917-374-2944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	03/03/2016

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