Provider Demographics
NPI:1730122953
Name:BASKIN, ALAN ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROY
Last Name:BASKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 OLD HOOK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1381
Mailing Address - Country:US
Mailing Address - Phone:201-666-3900
Mailing Address - Fax:201-261-0505
Practice Address - Street 1:316 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-1724
Practice Address - Country:US
Practice Address - Phone:201-385-6161
Practice Address - Fax:201-385-1671
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02458800207R00000X
NY0948041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ112927088OtherRAILROAD MEDICARE
AB05026510OtherEMPIRE BLUE CROSS BLUE SHIELD
136387Medicare PIN
AB05026510OtherEMPIRE BLUE CROSS BLUE SHIELD