Provider Demographics
NPI:1659471373
Name:CANTO, BASILISA HAYDEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BASILISA
Middle Name:HAYDEE
Last Name:CANTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1131
Mailing Address - Country:US
Mailing Address - Phone:718-268-2772
Mailing Address - Fax:718-268-2772
Practice Address - Street 1:10933 71ST RD STE 1E
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4813
Practice Address - Country:US
Practice Address - Phone:718-268-2772
Practice Address - Fax:718-268-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2186362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01589940Medicaid
NY04681Medicare PIN
NY01589940Medicaid