Healthcare Provider Details

I. General information

NPI: 1609337435
Provider Name (Legal Business Name): ALICE BASIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVENUE DEPT. OF PEDIATRICS
ALBANY NY
12208
US

IV. Provider business mailing address

47 NEW SCOTLAND AVENUE DEPT. OF PEDIATRICS
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5588
  • Fax: 518-262-5589
Mailing address:
  • Phone: 518-262-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64133
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: