| Marvin Base MD PC | |
|
210-08 Northern Blvd Bayside NY 11361 | |
| (718) 281-4461 | |
| (718) 281-0566 |
| Full Name | Marvin Base MD PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 210-08 Northern Blvd, Bayside, New York |
| Authorized Official Name and Position | Marvin Base (PHYSICIAN/PRINCIPAL) |
| Authorized Official Contact | 7182814461 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marvin Base MD PC 210-08 Northern Blvd Bayside NY 11361 Ph: (718) 281-4461 | Marvin Base MD PC 210-08 Northern Blvd Bayside NY 11361 Ph: (718) 281-4461 |
| NPI Number | 1114204682 |
|---|---|
| Provider Enumeration Date | 11/10/2011 |
| Last Update Date | 11/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114204682 | NPI | - | NPPES |
| 01888251 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | NY187770 (New York) | Primary |
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