Provider Demographics
NPI:1053034496
Name:WAKSZUL, BAS-SHEVA
Entity type:Individual
Prefix:
First Name:BAS-SHEVA
Middle Name:
Last Name:WAKSZUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 DAHILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1701
Mailing Address - Country:US
Mailing Address - Phone:718-436-0605
Mailing Address - Fax:
Practice Address - Street 1:812 DAHILL RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1701
Practice Address - Country:US
Practice Address - Phone:718-436-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator