Provider Demographics
NPI:1295736239
Name:BASILE, MARIA ARO (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ARO
Last Name:BASILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:41 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2160
Mailing Address - Country:US
Mailing Address - Phone:631-331-4672
Mailing Address - Fax:631-331-4239
Practice Address - Street 1:41 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2160
Practice Address - Country:US
Practice Address - Phone:631-331-4672
Practice Address - Fax:631-331-4239
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206665208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000371Medicare ID - Type Unspecified
NYH24538Medicare UPIN