Healthcare Provider Details

I. General information

NPI: 1992426969
Provider Name (Legal Business Name): MBIP PODIATRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 HUGUENOT AVE
STATEN ISLAND NY
10312-4315
US

IV. Provider business mailing address

1042 HUGUENOT AVE
STATEN ISLAND NY
10312-4315
US

V. Phone/Fax

Practice location:
  • Phone: 718-317-5215
  • Fax: 718-317-5212
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MINA BASKHRON
Title or Position: PODIATRIST - FOOT & ANKLE SURGERY
Credential: DPM, FACFAS, FACPM
Phone: 718-317-5215