Provider Demographics
NPI:1790793537
Name:QAYYUM, BASIT (MD)
Entity type:Individual
Prefix:DR
First Name:BASIT
Middle Name:
Last Name:QAYYUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8303
Mailing Address - Country:US
Mailing Address - Phone:646-370-2010
Mailing Address - Fax:
Practice Address - Street 1:314 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8303
Practice Address - Country:US
Practice Address - Phone:646-370-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231413207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3717244OtherCIGNA
134290262OtherEMPIRE UNITED
1799832OtherGHI
P2506392OtherUNITED HEALTHCARE
7815631OtherAETNA
2C9609OtherHEALTHNET
134290262OtherMAGNACARE
2C9609OtherHEALTHNET
134290262OtherMAGNACARE