Healthcare Provider Details

I. General information

NPI: 1154836153
Provider Name (Legal Business Name): MARK E BASIRATMAND N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 WALLABOUT ST
BROOKLYN NY
11249-7830
US

IV. Provider business mailing address

74 WALLABOUT ST
BROOKLYN NY
11249-7830
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-4600
  • Fax:
Mailing address:
  • Phone: 718-260-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345760
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: