Provider Demographics
NPI:1508874553
Name:ISSA BASCH, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ISSA BASCH
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 1:530 OLD COUNTRY ROAD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-333-7272
Mailing Address - Fax:516-333-2519
Practice Address - Street 1:530 OLD COUNTRY ROAD
Practice Address - Street 2:SUITE 1B
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-333-7272
Practice Address - Fax:516-333-2519
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
122515OtherVYTRA
218536OtherHIP
7554188OtherUS HEALTHCARE PPO
P2128241OtherOXFORD
02168647OtherMEDICAID
1000021373OtherAFFINITY
0972912OtherCIGNA #30
2485675OtherUS HEALTHCARE HMO
000000068154OtherGHI
218536A27OtherHEALTHFIRST
3466941OtherUNTD HLTHCARE PIN 2033408
3C3877OtherHEALTHNET
NY02168647Medicaid
BE8536OtherATLANTIS
2239955OtherFIRST HEALTH
553Z21OtherBCBS
12050374OtherMULITPLAN
AA72155OtherMDNY