Provider Demographics
NPI:1043547144
Name:HORST, BASIL A (MD)
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:A
Last Name:HORST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29211
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-9211
Mailing Address - Country:US
Mailing Address - Phone:212-305-2155
Mailing Address - Fax:212-927-9704
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:VC15-207
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-2155
Practice Address - Fax:212-927-9704
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003464207ND0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology