Individual
GINA M BASELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
133-03 JAMAICA AVENUE, RICHMOND HILL, NY 11418
(718) 657-7093
(718) 558-5314
Mailing address
80 MARCUS DR, PROVIDER ENROLLMENT, MELVILLE, NY 11747-4230
(631) 391-7887
(631) 454-4163
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
222962
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02312554
—
NY
Enumeration date
04/06/2006
Last updated
01/17/2013
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