Individual
NISON BASALILOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1 BROOKDALE PLZ, BROOKLYN, NY 11212-3198
(718) 240-5000
Mailing address
6836 108TH ST APT A14, FOREST HILLS, NY 11375-3348
(646) 712-3823
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
007370
NY
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P115473
NY
Other
Enumeration date
03/30/2022
Last updated
04/29/2026
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