Healthcare Provider Details

I. General information

NPI: 1649655580
Provider Name (Legal Business Name): BASMA ELSAWY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1701
US

IV. Provider business mailing address

2935 OCEAN PKWY APT 5A
BROOKLYN NY
11235-8037
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-1732
  • Fax: 718-442-0189
Mailing address:
  • Phone: 917-588-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number295442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: