Healthcare Provider Details

I. General information

NPI: 1821790213
Provider Name (Legal Business Name): BASMAH RANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 MAMARONECK AVE
MAMARONECK NY
10543-5910
US

IV. Provider business mailing address

689 MAMARONECK AVE
MAMARONECK NY
10543-5910
US

V. Phone/Fax

Practice location:
  • Phone: 914-632-2737
  • Fax:
Mailing address:
  • Phone: 914-632-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: