Individual
MARICON BAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
480 FOREST AVE, LOCUST VALLEY, NY 11560-2151
(516) 759-5406
Mailing address
73 7TH AVE N, HUNTINGTON STATION, NY 11746-2208
(631) 948-4040
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
643137
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
309238
NY
Other
Enumeration date
09/23/2013
Last updated
10/09/2024
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