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General NPI Number Information
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NPI Number | 1679363154
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Entity Type | Individual
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Provider Name | MAX BASILE
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Gender | Male
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 369 LEXINGTON AVE RM 14A
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City | NEW YORK
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State | NY
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Zip | 10017-6526
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Country | US
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Telephone | 602-723-0098
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Fax |
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Provider Business Mailing Address
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Address Line | 206 WARREN ST APT 2R
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City | JERSEY CITY
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State | NJ
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Zip | 07302-4448
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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 |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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