Provider Demographics
NPI:1568766129
Name:BASMALA MEDICAL P.C.
Entity Type:Organization
Organization Name:BASMALA MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-1717
Mailing Address - Street 1:162 E 78TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0406
Mailing Address - Country:US
Mailing Address - Phone:212-879-1717
Mailing Address - Fax:212-879-4025
Practice Address - Street 1:162 E 78TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0406
Practice Address - Country:US
Practice Address - Phone:212-879-1717
Practice Address - Fax:212-879-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231996207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty