MEDICARE: KAYLA BASEDOW

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	207P00000X	Emergency Medicine Physician	341860-01	NY

General Provider Information

NPI Number	:	1518607175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA BASEDOW

Provider Business Mailing Address
First Line	:	1 GUSTAVE L LEVY PL # 1149
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL # 1149
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6504
Country	:	US
Telephone Number	:	212-824-8069
Fax Number	:

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

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	04/13/2026

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Directions to “ KAYLA BASEDOW ” Practice Location

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