Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 204397 | NY |
NPI | 1003814351 |
---|---|
Provider Name | Dr. Rajinder Basra |
First Address | Clarence Center, NY 14032-9722 |
Second Address | Batavia, NY 14020-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 28/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F92553 | (02) | NY |