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General NPI Number Information
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NPI Number | 1548589161
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Entity Type | Individual
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Provider Name | BAHAR TASTAN BAS R.P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 1980 CROMPOND RD
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567-4144
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Country | US
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Telephone | 914-734-3490
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Fax | 914-734-3495
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Provider Business Mailing Address
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Address Line | 400 E MAIN ST
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3477
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Country | US
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Telephone | 914-362-6270
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Fax | 914-242-7681
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 013929
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License Number State | NY
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