Healthcare Provider Details

I. General information

NPI: 1578634952
Provider Name (Legal Business Name): MAHA K BASSILA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAM 3415 BAINBRIDGE AVE, 5TH FLOOR
BRONX NY
10467
US

IV. Provider business mailing address

1376 MIDLAND AVE APT. 303
BRONXVILLE NY
10708-6891
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4646
  • Fax:
Mailing address:
  • Phone: 718-920-4646
  • Fax: 718-944-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number159933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: