Basdai Mohammed, RN
Individual provider Active NPI School Registered Nurse · Middlevillage Queens, NY
NPI 1780950626 · NPPES record last updated Mar 26, 2012
Key facts
- NPI
- 1780950626
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Registered Nurse 163WS0200X
- License
- 457729-1 (NY)
- Practice address
- 691065 Drive
Ps128Q
Middlevillage Queens, NY 11379 - Phone
- (718) 326-6250
- Fax
- (718) 326-6251
- NPI assigned
- Mar 26, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 457729-1 | NY | MD | School Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | 457729-1 | NY | Yes |
Addresses
Primary practice location
691065 Drive
Ps128Q
Middlevillage Queens, NY 11379
Mailing address
69-10 65Drive
Middlevillage Queens, NY 11379
Phone (718) 326-6250
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LISA0277 | Medicaid | NY |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.