=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437162088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BASIT QAYYUM D O P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 04/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 E 30TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-370-2010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 655
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10113-0655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-312-6712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. BASIT QAYYUM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-312-6712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------