Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 145614 | NY |
NPI | 1013952431 |
---|---|
Provider Name | Jharna Basak |
First Address | Buffalo, NY 14210-2450 |
Second Address | Buffalo, NY 14210-2450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010200501 | UNIVERA (01) | NY |
6490002 | INDEPENDENT HEALTH ASSOC. (01) | NY |
D01453 | (02) | NY |