Provider Demographics
NPI:1750469094
Name:TAHA, BASIRAH (CNS)
Entity Type:Individual
Prefix:
First Name:BASIRAH
Middle Name:
Last Name:TAHA
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HOES LN
Mailing Address - Street 2:P. O. BOX 1392
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5627
Mailing Address - Country:US
Mailing Address - Phone:732-235-5940
Mailing Address - Fax:732-235-2408
Practice Address - Street 1:671 HOES LN
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5627
Practice Address - Country:US
Practice Address - Phone:800-969-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO101151163W00000X
NJNC101151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
021471PSYMedicare ID - Type Unspecified
S67562Medicare UPIN