Provider Demographics
NPI:1508863507
Name:STEPHEN W. BASSIN, P.T., P.C.
Entity Type:Organization
Organization Name:STEPHEN W. BASSIN, P.T., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-793-7136
Mailing Address - Street 1:32 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2839
Mailing Address - Country:US
Mailing Address - Phone:518-793-7136
Mailing Address - Fax:518-793-7142
Practice Address - Street 1:32 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2839
Practice Address - Country:US
Practice Address - Phone:518-793-7136
Practice Address - Fax:518-793-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSB0Q576810OtherEMPIRE BC/BS
NY02594365Medicaid
AA1000Medicare UPIN
NYSB0Q576810OtherEMPIRE BC/BS