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General NPI Number Information
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NPI Number | 1548646417
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Entity Type | Individual
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Provider Name | MARIAM BASIR D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 320 E 94TH ST SECOND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10128-5604
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Country | US
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Telephone | 262-424-4056
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Fax |
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Provider Business Mailing Address
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Address Line | 18875 BROOKRIDGE DR
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City | BROOKFIELD
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State | WI
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Zip | 53045-8150
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Country | US
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Telephone | 262-424-4056
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 281246
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License Number State | NY
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