Provider Demographics
NPI:1013065788
Name:ELFAHAM, BASEM SADEK (MD)
Entity Type:Individual
Prefix:DR
First Name:BASEM
Middle Name:SADEK
Last Name:ELFAHAM
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 1:9 WOODFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2400
Mailing Address - Country:US
Mailing Address - Phone:631-553-6855
Mailing Address - Fax:
Practice Address - Street 1:9 WOODFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2400
Practice Address - Country:US
Practice Address - Phone:631-553-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine