Provider Demographics
NPI:1356948392
Name:BASKHAROUN-GUIRGUIS, MAGDA F (PDD)
Entity type:Individual
Prefix:DR
First Name:MAGDA
Middle Name:F
Last Name:BASKHAROUN-GUIRGUIS
Suffix:
Gender:F
Credentials:PDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 STRICKLAND AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6408
Mailing Address - Country:US
Mailing Address - Phone:888-826-3349
Mailing Address - Fax:844-628-5009
Practice Address - Street 1:6103 STRICKLAND AVE STE D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6408
Practice Address - Country:US
Practice Address - Phone:888-826-3349
Practice Address - Fax:844-628-5009
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBASKM1247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBASKM1OtherCQ - CERTIFICATE OF QUALITY