M,Bastawros,Physician,P.C.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

126414 Issued in NY

Legal business name

M,BASTAWROS,PHYSICIAN,P.C.

Doing business as

none

Practice address

314 Seaview Ave
Staten Island, NY 10305-2246

Phone

(718) 668-3417

Fax

(718) 668-3420

NPI assigned

Jul 15, 2014

Last updated

Jul 15, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mary N Bastawros, MDNPI 1881616738

Title

President

Phone

(718) 668-3417

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• none Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Nabil Bastawros, MD

  • Pediatrics Physician
  • Staten Island, NY
  • NPI 1881616738
  Authorized official Same address or phone

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1720495328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103052246",
            "telephone_number": "718-668-3417",
            "fax_number": "718-668-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103052246",
            "telephone_number": "718-668-3417",
            "fax_number": "718-668-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M,BASTAWROS,PHYSICIAN,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "BASTAWROS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-668-3417",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NY",
            "license": "126414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00597044",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "none",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Diane Lynn, L.C.S.W
• Deborah J Lyons-Sparacio, PA
• Ashley M Lyons
• Miriam Lyubina
• M Valvo Inc.
• M. H. Aly, MD, P.C.
• M.E.P.T. Physical Therapy, P.C.
• M.U.F. Medical Supplies Corp. (Wellness Medical Supplies)
• M&G Medical PC
• Daniel Ma

• Exclusive Provider Organization in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Exclusive Provider Organization in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.