Healthcare Provider Details

I. General information

NPI: 1790487643
Provider Name (Legal Business Name): BASIL BABY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 NEW HYDE PARK RD STE 401
NEW HYDE PARK NY
11042-1214
US

IV. Provider business mailing address

3003 NEW HYDE PARK RD STE 401
NEW HYDE PARK NY
11042-1214
US

V. Phone/Fax

Practice location:
  • Phone: 516-224-2400
  • Fax:
Mailing address:
  • Phone: 516-224-2400
  • Fax: 516-224-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number345177
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberW5731
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: