Provider Demographics
NPI: | 1790793537 |
---|---|
Name: | QAYYUM, BASIT (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | BASIT |
Middle Name: | |
Last Name: | QAYYUM |
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: | 314 E 30TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10016-8303 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 646-370-2010 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 314 E 30TH ST |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10016-8303 |
Practice Address - Country: | US |
Practice Address - Phone: | 646-370-2010 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-08-04 |
Last Update Date: | 2011-07-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 231413 | 207RR0500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
3717244 | Other | CIGNA | |
134290262 | Other | EMPIRE UNITED | |
1799832 | Other | GHI | |
P2506392 | Other | UNITED HEALTHCARE | |
7815631 | Other | AETNA | |
2C9609 | Other | HEALTHNET | |
134290262 | Other | MAGNACARE | |
2C9609 | Other | HEALTHNET | |
134290262 | Other | MAGNACARE |