Provider Demographics
NPI:1972275253
Name:BASSI, ANKUR
Entity Type:Individual
Prefix:
First Name:ANKUR
Middle Name:
Last Name:BASSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ETHERINGTON CRES
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9653
Mailing Address - Country:US
Mailing Address - Phone:585-474-8515
Mailing Address - Fax:
Practice Address - Street 1:31 ETHERINGTON CRES
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14428-9653
Practice Address - Country:US
Practice Address - Phone:585-474-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY708214163W00000X
NY348078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse