Provider Demographics
NPI:1003062050
Name:YURCISIN, BASIL MICHAEL II (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIL
Middle Name:MICHAEL
Last Name:YURCISIN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:225 MILLBURN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1737
Mailing Address - Country:US
Mailing Address - Phone:973-218-1990
Mailing Address - Fax:973-629-1274
Practice Address - Street 1:225 MILLBURN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1737
Practice Address - Country:US
Practice Address - Phone:973-218-1990
Practice Address - Fax:973-629-1274
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08777400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery