Provider Demographics
NPI:1740545953
Name:RAWYA BASKHAROUN
Entity type:Organization
Organization Name:RAWYA BASKHAROUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAWYA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BASKHAROUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-724-3919
Mailing Address - Street 1:7510 4TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-833-7063
Mailing Address - Fax:
Practice Address - Street 1:7510 4TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3244
Practice Address - Country:US
Practice Address - Phone:718-833-7063
Practice Address - Fax:718-833-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184170174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty