Provider Demographics
NPI:1518206366
Name:BASUK MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:BASUK MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-810-0561
Mailing Address - Street 1:2011 UNION BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8030
Mailing Address - Country:US
Mailing Address - Phone:631-666-2900
Mailing Address - Fax:631-666-2900
Practice Address - Street 1:2011 UNION BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8030
Practice Address - Country:US
Practice Address - Phone:631-666-2900
Practice Address - Fax:631-666-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty