Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 147014 | NY |
NPI | 1033194675 |
---|---|
Provider Name | Dr. Paul M Basuk |
First Address | New York, NY 10021-4726 |
Second Address | New York, NY 10021-4726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C04259 | (02) | NY |