Provider Demographics
NPI:1184885238
Name:BAS, MARIA DIBARI
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DIBARI
Last Name:BAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FRONTIER TRL
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2526
Mailing Address - Country:US
Mailing Address - Phone:631-874-8024
Mailing Address - Fax:
Practice Address - Street 1:16 FRONTIER TRL
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2526
Practice Address - Country:US
Practice Address - Phone:631-874-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010449-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist