Provider Demographics
NPI:1902883812
Name:PAKEMAN, BASIL ADRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:ADRIAN
Last Name:PAKEMAN
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 1:240 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-308-1566
Mailing Address - Fax:212-758-1497
Practice Address - Street 1:240 E 64TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-308-1566
Practice Address - Fax:212-758-1497
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207516207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PB7516OtherATLANTIS HC
NY02103097Medicaid
2455898OtherAETNA
2455893HMOOtherAETNA INC
462281OtherBCBS & EMPIRE BCBS
P11144086OtherMULTIPLAN
7365160OtherAETNA
7365160PPOOtherAETNA INC
P2129698OtherOXFORD HC
7365160PPOOtherAETNA INC
H16070Medicare UPIN