Individual
BORIS BASANILOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
2201 HEMPSTEAD TURNPIKE, NASSAU UNIVERSITY MEDICAL CENTER, EAST MEADOW, NY 11554
(516) 572-6131
(516) 572-5793
Mailing address
2201 HEMPSTEAD TURNPIKE, NASSAU UNIVERSITY MEDICAL CENTER, EAST MEADOW, NY 11554
(516) 572-6131
(516) 572-5793
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
63 014098
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63 014098
LICENSE#
NY
Enumeration date
02/20/2009
Last updated
02/20/2009
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