Healthcare Provider Details

I. General information

NPI: 1710984703
Provider Name (Legal Business Name): MUHAMMAD OMER BASHIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 AUTUMN CHASE DR
HOPEWELL JUNCTION NY
12533-6574
US

IV. Provider business mailing address

146 AUTUMN CHASE DR
HOPEWELL JUNCTION NY
12533-6574
US

V. Phone/Fax

Practice location:
  • Phone: 631-627-9987
  • Fax:
Mailing address:
  • Phone: 631-627-9987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number247070
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number247070
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number247070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: