Provider Demographics
NPI:1386206308
Name:BASHIRU, ABUBAKAR
Entity Type:Individual
Prefix:MR
First Name:ABUBAKAR
Middle Name:
Last Name:BASHIRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 CROTONA AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2771
Mailing Address - Country:US
Mailing Address - Phone:347-993-6883
Mailing Address - Fax:
Practice Address - Street 1:2130 CROTONA AVE APT 6B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2771
Practice Address - Country:US
Practice Address - Phone:718-295-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer