Provider Demographics
NPI:1013084201
Name:BASTIEN, JOCELYNE (MD,)
Entity type:Individual
Prefix:DR
First Name:JOCELYNE
Middle Name:
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:JOCELYNE
Other - Middle Name:
Other - Last Name:MILORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:915 EDWARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1322
Mailing Address - Country:US
Mailing Address - Phone:516-561-6874
Mailing Address - Fax:
Practice Address - Street 1:170 W 12TH ST
Practice Address - Street 2:NURSES RESIDENCE 5 TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8202
Practice Address - Country:US
Practice Address - Phone:212-604-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR15,9472084P0804X
NY0111391363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical