Provider Demographics
NPI:1134511603
Name:BASATI, SIMRONJEET (BDS, DDS)
Entity Type:Individual
Prefix:
First Name:SIMRONJEET
Middle Name:
Last Name:BASATI
Suffix:
Gender:F
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 30TH ST
Mailing Address - Street 2:APT 1Y
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 JOHN ST
Practice Address - Street 2:SUITE 530
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3101
Practice Address - Country:US
Practice Address - Phone:212-619-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0577291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics