Provider Demographics
NPI:1629677976
Name:BASSITY, ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BASSITY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:WADDINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:13694-3103
Mailing Address - Country:US
Mailing Address - Phone:607-262-6240
Mailing Address - Fax:
Practice Address - Street 1:529 5TH ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MT
Practice Address - Zip Code:59213
Practice Address - Country:US
Practice Address - Phone:406-786-3202
Practice Address - Fax:406-412-2993
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-233680363LF0000X
NY346837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14495500Medicaid