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General NPI Number Information
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NPI Number | 1871510883
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Entity Type | Individual
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Provider Name | BASHIR ABDUL-WADUD PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 5 PALISADES DR STE 100
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City | ALBANY
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State | NY
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Zip | 12205-6433
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Country | US
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Telephone | 518-438-4496
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Fax | 518-438-5803
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Provider Business Mailing Address
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Address Line | PO BOX 14890
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City | ALBANY
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State | NY
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Zip | 12212-4890
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Country | US
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Telephone | 518-525-5634
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Fax | 518-649-4094
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1876
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA057997
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License Number State | PA
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