Provider Demographics
NPI:1407854565
Name:ALDAIA, BASSAM NICOLA (MD)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:NICOLA
Last Name:ALDAIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 92ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3621
Mailing Address - Country:US
Mailing Address - Phone:718-836-1598
Mailing Address - Fax:718-836-7672
Practice Address - Street 1:660 92ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3621
Practice Address - Country:US
Practice Address - Phone:718-836-1598
Practice Address - Fax:718-836-7672
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-02-12
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NY128836207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY128836OtherHIP
NY354121OtherBLUE CROSS
OP222OtherOXFORD HEALTHPLAN
NY00339717Medicaid
NY0201503OtherGHI
0555852OtherAETNA
B13659Medicare UPIN
NY00339717Medicaid