Provider Demographics
NPI:1063908523
Name:SALLICK, BASMATIE (FNP)
Entity type:Individual
Prefix:
First Name:BASMATIE
Middle Name:
Last Name:SALLICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 MCCLELLAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1020
Mailing Address - Country:US
Mailing Address - Phone:518-382-2260
Mailing Address - Fax:518-347-5812
Practice Address - Street 1:624 MCCLELLAN ST STE 101
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304
Practice Address - Country:US
Practice Address - Phone:518-382-2260
Practice Address - Fax:518-347-5812
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343129363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner