Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 259743 | NY |
N | 208000000X | Pediatrician | 259743 | NY |
NPI | 1104120625 |
---|---|
Provider Name | Dr. Jennifer Alisha Bassetti |
First Address | New York, NY 10021-4872 |
Second Address | New York, NY 10021-4872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2010 |
Last Update Date | 25/06/2019 |