Healthcare Provider Details

I. General information

NPI: 1881350882
Provider Name (Legal Business Name): ANITA BASSEY AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CHRISTOPHER LN STE 201
STATEN ISLAND NY
10314-1650
US

IV. Provider business mailing address

90 AMPERE PKWY
EAST ORANGE NJ
07017-5429
US

V. Phone/Fax

Practice location:
  • Phone: 929-367-0510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: