Provider Demographics
NPI:1447575691
Name:BASRA, SUNEEL K (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUNEEL
Middle Name:K
Last Name:BASRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 WESCOTT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4671
Mailing Address - Country:US
Mailing Address - Phone:908-782-0600
Mailing Address - Fax:908-782-7575
Practice Address - Street 1:8100 WESCOTT DR STE 101
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4671
Practice Address - Country:US
Practice Address - Phone:908-782-0600
Practice Address - Fax:908-782-7575
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006335213ES0103X
NJ25MD00304000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery