Individual
DR. KEVIN R BASRALIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
360 ESSEX ST, SUITE 403, HACKENSACK, NJ 07601-8550
(551) 996-8090
(551) 996-8221
Mailing address
360 ESSEX ST, SUITE 403, HACKENSACK, NJ 07601-8550
(551) 996-8090
(551) 996-8221
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA04654700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103347000
AMERIHEALTH HMO ID #
NJ
01
—
0457763
AETNA HMO ID #
NJ
05
—
1211200
—
NJ
01
—
340001947
RAILROAD MDCR #
NJ
01
—
4239813
AETNA PPO ID #
NJ
01
—
5S1641
BCBS NY CARLSTADT
NJ
01
—
80D693
BC/BS NY (HACKENSACK) #
NJ
01
—
BS138
OXFORD ID #
NJ
Enumeration date
08/09/2005
Last updated
12/16/2014
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