Provider Demographics
NPI:1902803786
Name:BASSIN, STEPHEN WAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WAYNE
Last Name:BASSIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STEPHEN W. BASSIN, P.T., P.C.
Mailing Address - Street 2:32 SHERMAN AVE
Mailing Address - City:GLEN FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-793-7136
Mailing Address - Fax:518-793-7142
Practice Address - Street 1:STEPHEN W. BASSIN, P.T., P.C.
Practice Address - Street 2:32 SHERMAN AVE
Practice Address - City:GLEN FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-793-7136
Practice Address - Fax:518-793-7142
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSB0Q576810OtherEMPIRE BC/BS
NY00998141Medicaid
NY000492049001OtherBLUESHIELD OF NE NY
NYSB0Q576810OtherEMPIRE BC/BS
NYCC8136Medicare ID - Type Unspecified