Provider Demographics
NPI:1144548843
Name:BASITH, MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:BASITH
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 1:9747 77TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1943
Mailing Address - Country:US
Mailing Address - Phone:718-877-7407
Mailing Address - Fax:
Practice Address - Street 1:9747 77TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1943
Practice Address - Country:US
Practice Address - Phone:718-877-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine