Individual
MS. TRINA BINTA BASCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11207 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-1031
(917) 361-4502
Mailing address
11207 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-1031
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402773
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
610850
—
NY
Enumeration date
12/11/2018
Last updated
06/27/2022
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