Healthcare Provider Details

I. General information

NPI: 1407854565
Provider Name (Legal Business Name): BASSAM NICOLA ALDAIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

660 92ND ST
BROOKLYN NY
11228-3621
US

IV. Provider business mailing address

660 92ND ST
BROOKLYN NY
11228-3621
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-1598
  • Fax: 718-836-7672
Mailing address:
  • Phone: 718-836-1598
  • Fax: 718-836-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number128836
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: