Provider Demographics
NPI:1750882247
Name:BASSEM ELDAIF MD PA
Entity type:Organization
Organization Name:BASSEM ELDAIF MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDAIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-215-4799
Mailing Address - Street 1:2085 HIGHWAY A1A APT 3301
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-1804
Mailing Address - Country:US
Mailing Address - Phone:954-294-1963
Mailing Address - Fax:866-682-6309
Practice Address - Street 1:6032 FARCENDA PL STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-215-4799
Practice Address - Fax:321-252-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty