Provider Demographics
NPI:1679769715
Name:BASELUOS, CINDY (MD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BASELUOS
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 1:651 W MOUNT PLEASANT AVE
Mailing Address - Street 2:EMERGENCY MEDICAL ASSOCIATES
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVE
Practice Address - Street 2:RUMC - DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1664
Practice Address - Country:US
Practice Address - Phone:718-818-2995
Practice Address - Fax:718-818-2995
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY257249207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY257249OtherNEW YORK STATE MEDICAL LICENSE