Organization
M,BASTAWROS,PHYSICIAN,P.C.
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY N BASTAWROS MD (PRESIDENT)
(718) 668-3417
Entity
Organization
Contact information
Practice address
314 SEAVIEW AVE, STATEN ISLAND, NY 10305-2246
(718) 668-3417
(718) 668-3420
Mailing address
314 SEAVIEW AVE, STATEN ISLAND, NY 10305-2246
(718) 668-3417
(718) 668-3420
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
126414
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00597044
—
NY
Enumeration date
07/15/2014
Last updated
07/15/2014
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