Provider Demographics
NPI:1275918096
Name:DR OMAR BASHAYAN PHYSICIAN PLLC
Entity Type:Organization
Organization Name:DR OMAR BASHAYAN PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-374-2944
Mailing Address - Street 1:155 W 68TH ST APT 1102
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5816
Mailing Address - Country:US
Mailing Address - Phone:917-374-2944
Mailing Address - Fax:718-334-3441
Practice Address - Street 1:155 W 68TH ST APT 1102
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5816
Practice Address - Country:US
Practice Address - Phone:917-374-2944
Practice Address - Fax:718-334-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2654952084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty