Provider Demographics
NPI:1861161697
Name:TESSIER CLOUTIER, BASILE (MD)
Entity type:Individual
Prefix:
First Name:BASILE
Middle Name:
Last Name:TESSIER CLOUTIER
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 1:2810 JACKSON AVE APT 40M
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3181
Mailing Address - Country:US
Mailing Address - Phone:212-639-5421
Mailing Address - Fax:
Practice Address - Street 1:2810 JACKSON AVE APT 40M
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3181
Practice Address - Country:US
Practice Address - Phone:212-639-5421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309700207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology