Provider Demographics
NPI:1588141626
Name:BASTOKY, NATAN (DO)
Entity type:Individual
Prefix:DR
First Name:NATAN
Middle Name:
Last Name:BASTOKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SE 3RD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-888-3800
Mailing Address - Fax:954-888-3808
Practice Address - Street 1:1801 W SAMPLE RD STE 101
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1370
Practice Address - Country:US
Practice Address - Phone:954-888-3800
Practice Address - Fax:954-888-3808
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-22
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15852207Q00000X
FLOS15852207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine