Organization
WILLIAM R BASTA MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BASTA M.D. (OWNER)
(516) 676-2878
Entity
Organization
Contact information
Practice address
3 SCHOOL ST, SUITE 303, GLEN COVE, NY 11542-2590
(516) 676-2878
(516) 674-2256
Mailing address
3 SCHOOL ST, SUITE 303, GLEN COVE, NY 11542-2590
(516) 676-2878
(516) 674-2256
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Enumeration date
02/14/2012
Last updated
02/14/2012
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