Provider Demographics
NPI:1841366713
Name:BASSELL, JAY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALAN
Last Name:BASSELL
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 1:825 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5349
Mailing Address - Country:US
Mailing Address - Phone:212-932-3027
Mailing Address - Fax:
Practice Address - Street 1:147-32 JAMAICA AVENUE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4042
Practice Address - Country:US
Practice Address - Phone:718-786-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160412207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY976020OtherUNITED HEALTHCARE
NY01103259Medicaid
NY65N652OtherBLUE CROSS BLUE SHIELD
NY9507194OtherGHI
NY10000024896OtherAFFINITY
NY4353664OtherAETNA
NY01103259Medicaid