Provider Demographics
NPI:1295784445
Name:BASIT, MOHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:BASIT
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 1:12 COE FARM RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2910
Mailing Address - Country:US
Mailing Address - Phone:718-220-4210
Mailing Address - Fax:718-220-4235
Practice Address - Street 1:2951 GRAND CONCOURSE APT 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1431
Practice Address - Country:US
Practice Address - Phone:718-220-4210
Practice Address - Fax:718-220-4235
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6301200207RP1001X
NY199852207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01831772Medicaid
NY01831772Medicaid
NYG16077Medicare UPIN