Provider Demographics
NPI:1417997198
Name:BASINSKI, DANIEL (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BASINSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 OAK POINT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4100
Mailing Address - Country:US
Mailing Address - Phone:440-222-4150
Mailing Address - Fax:440-222-4971
Practice Address - Street 1:5940 OAK POINT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4100
Practice Address - Country:US
Practice Address - Phone:440-222-4150
Practice Address - Fax:440-222-4971
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001027RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080257Medicaid