Healthcare Provider Details

I. General information

NPI: 1700440351
Provider Name (Legal Business Name): BASEM HAKIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PARK AVE
HUNTINGTON NY
11743-2799
US

IV. Provider business mailing address

270 PARK AVE
HUNTINGTON NY
11743-2799
US

V. Phone/Fax

Practice location:
  • Phone: 631-760-2852
  • Fax:
Mailing address:
  • Phone: 631-760-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number007236
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number007236
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: