Basic Information
Provider Information
NPI: 1003009002
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BASIN
FirstName: MAYA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RPH.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 250 174TH ST
Address2: APT 704
City: SUNNY ISLES BEACH
State: FL
PostalCode: 331603323
CountryCode: US
TelephoneNumber: 9173590977
FaxNumber:  
Practice Location
Address1: 250 174TH ST
Address2: APT 704
City: SUNNY ISLES BEACH
State: FL
PostalCode: 331603323
CountryCode: US
TelephoneNumber: 9173590977
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/22/2007
LastUpdateDate: 01/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XPS47269FLN Pharmacy Service ProvidersPharmacist 
183500000X28RI03417200NJN Pharmacy Service ProvidersPharmacist 
183500000X047436NYY Pharmacy Service ProvidersPharmacist 

ID Information
IDTypeStateIssuerDescription
04743601NYPHARMACISTOTHER
PS4726901FLPHARMACISTOTHER
28RI0341720001NJPHARMACISTOTHER


Home