Leo Jan Bastiaens, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

171146 Issued in NY

Practice address

1620 Route 22 Ste 203
Brewster, NY 10509-4052

Phone

(845) 278-2500

Fax

(844) 454-5096

NPI assigned

Oct 10, 2005

Last updated

Apr 6, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1235127754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 HERITAGE HLS UNIT A",
            "city": "SOMERS",
            "state": "NY",
            "postal_code": "105894048",
            "telephone_number": "412-334-3393",
            "fax_number": "844-454-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 ROUTE 22 STE 203",
            "city": "BREWSTER",
            "state": "NY",
            "postal_code": "105094052",
            "telephone_number": "845-278-2500",
            "fax_number": "844-454-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIAENS",
        "first_name": "LEO",
        "middle_name": "JAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "171146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06049783",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janice Barbara
• Joann Barbaro, LPN
• Ruth Rhea Baron, PSY.D.
• Cheryll Anne Barrett, L.P.N.
• Talia Baslow
• Jessica Batterson
• Nina Battista
• John Joseph Bauer Sr.
• Grace Eva Beach, LMSW
• Bedford Psychological Services P.C.

• Child & Adolescent Psychiatry Physician in Brewster, NY
• Providers in Brewster, NY by specialty
• Child & Adolescent Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.