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General NPI Number Information
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NPI Number | 1528947041
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Entity Type | Organization
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Legal Business Name | KEYSTONE PODIATRY
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 443 LINDEN BLVD
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City | BROOKLYN
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State | NY
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Zip | 11203-2821
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Country | US
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Telephone | 718-282-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 10540 63RD AVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-1337
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | NISON BASALILOV
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Credential | DPM
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Telephone | 347-799-5989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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