Provider Demographics
NPI:1356703409
Name:BAGHAL, BASEL (DO)
Entity type:Individual
Prefix:DR
First Name:BASEL
Middle Name:
Last Name:BAGHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1001
Mailing Address - Country:US
Mailing Address - Phone:201-464-4755
Mailing Address - Fax:201-464-4758
Practice Address - Street 1:1 MAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1001
Practice Address - Country:US
Practice Address - Phone:201-464-4755
Practice Address - Fax:201-464-4758
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10634800207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program