Provider Demographics
NPI:1902915176
Name:BASACA, BELINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:BELINDA
Middle Name:
Last Name:BASACA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 FOREST AVE. 2ND FLOOR
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-759-0900
Mailing Address - Fax:519-759-0195
Practice Address - Street 1:86 FOREST AVE.
Practice Address - Street 2:2ND FLOOR SUITE D
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-759-0900
Practice Address - Fax:519-759-0195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYBB8479835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02585748OtherATLANTIS
NY02585748OtherCHILD HEALTH PLUS
NY02585748OtherCIGNA
NY02585748OtherCHOISE CARE
NY02585748OtherEMPIRE BS/BC
NY02585748Medicaid