OrganizationActive
M,bastawros,physician,p.c.
NPI 1720495328 · Exclusive Provider Organization · Staten Island, NY
Provider details
- NPI number
- 1720495328
- Entity type
- Organization
- Primary specialty
- Exclusive Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Mary Bastawros, President(718) 668-3417
- License
- 126414 (NY)
Specialties & taxonomies
Managed Care Organizations
Practice location
314 Seaview Ave
Staten Island, NY 10305-2246
Phone: (718) 668-3417
Fax: (718) 668-3420
Approximate (ZIP-level) locationGet directions
Mailing address
314 Seaview Ave
Staten Island, NY 10305-2246
Other names (DBA / former)
- Doing business as
- None
Registry dates
- Enumerated
- 2014-07-15
- Last updated
- 2014-07-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.