Provider Demographics
NPI:1558108720
Name:BASEM, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BASEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 YORK AVE APT 2J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3468
Mailing Address - Country:US
Mailing Address - Phone:347-561-8795
Mailing Address - Fax:
Practice Address - Street 1:3938 EVE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1553
Practice Address - Country:US
Practice Address - Phone:347-561-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357662174N00000X
NY052024CJB27374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula