MEDICARE: DR. BASIM ZAKI ADIB ED.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	103382	NY

General Provider Information

NPI Number	:	1275197832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASIM ZAKI ADIB ED.D

Provider Business Mailing Address
First Line	:	3555 BAINBRIDGE AVE APT 2A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-1474
Country	:	US
Telephone Number	:	917-609-3916
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-3904
Country	:	US
Telephone Number	:	914-713-5285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	04/29/2019

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