Healthcare Provider Details

I. General information

NPI: 1780751776
Provider Name (Legal Business Name): MEDICAL HEALTH ASSOCIATES OF BELLEROSE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24818 UNION TURNPIKE GROUND FLOOR
BELLEROSE NY
11426
US

IV. Provider business mailing address

24818 UNION TURNPIKE GROUND FLOOR
BELLEROSE NY
11426
US

V. Phone/Fax

Practice location:
  • Phone: 718-347-7621
  • Fax: 718-347-4564
Mailing address:
  • Phone: 718-347-7621
  • Fax: 718-347-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number184113-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number176820-2
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberF304231
License Number StateNY

VIII. Authorized Official

Name: DR. SANTO BASILEO
Title or Position: DIRECTOR
Credential: M.D.
Phone: 718-347-7621