Healthcare Provider Details

I. General information

NPI: 1245166446
Provider Name (Legal Business Name): BASMA MAHMOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MALTESE DR
MIDDLETOWN NY
10940-2115
US

IV. Provider business mailing address

14 RED OAK CT
MIDDLETOWN NY
10941-1671
US

V. Phone/Fax

Practice location:
  • Phone: 845-800-6840
  • Fax:
Mailing address:
  • Phone: 845-800-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: