Provider Demographics
NPI:1528060621
Name:BASSIUR, MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:BASSIUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-0387
Mailing Address - Country:US
Mailing Address - Phone:516-374-2266
Mailing Address - Fax:516-374-8999
Practice Address - Street 1:999 CENTRAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1205
Practice Address - Country:US
Practice Address - Phone:516-374-2266
Practice Address - Fax:516-374-8999
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2019-06-18
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
NY027392A204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD91751Medicare UPIN
NY6347200001Medicare NSC