Provider Demographics
NPI:1447616065
Name:BASSETT, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BASSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-09 28TH STREET
Mailing Address - Street 2:8TH FLOOR, OFFICE OF THE COMMISSIONER
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11101
Mailing Address - Country:US
Mailing Address - Phone:347-396-4100
Mailing Address - Fax:
Practice Address - Street 1:42-09 28TH STREET
Practice Address - Street 2:8TH FLOOR, OFFICE OF THE COMMISSIONER
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:347-396-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine