Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 027392A | NY |
NPI | 1528060621 |
---|---|
Provider Name | Dr. Martin Bassiur |
First Address | Woodmere, NY 11598-0387 |
Second Address | Woodmere, NY 11598-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 18/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D91751 | (02) | NY |