MEDICARE: DANIEL BASSIRI MD PLLC

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	207L00000X	Anesthesiology Physician	276629	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861942187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL BASSIRI MD PLLC

Provider Business Mailing Address
First Line	:	100 WILDWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1223
Country	:	US
Telephone Number	:	516-458-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WILDWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1223
Country	:	US
Telephone Number	:	516-458-2244
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL BASSIRI-TEHRANI
Credential	:
Telephone Number	:	516-458-2244

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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