Provider Demographics
NPI:1376541946
Name:ABEYSEKERA, BASIL S (MD)
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:S
Last Name:ABEYSEKERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEBSTER AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1361
Mailing Address - Country:US
Mailing Address - Phone:845-452-0555
Mailing Address - Fax:845-452-0550
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-452-0555
Practice Address - Fax:845-452-0550
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132098207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00517753Medicaid
NY00517753Medicaid
NY351191Medicare ID - Type Unspecified