Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 257883 | NY |
NPI | 1295948115 |
---|---|
Provider Name | Mr. Sushil Kumar Basra |
First Address | Commack, NY 11725-3131 |
Second Address | Commack, NY 11725-3131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 05/01/2011 |