Provider Demographics
NPI:1477638500
Name:BASCON, ROSARIO A (MD)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:A
Last Name:BASCON
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 1:34 NIMITZ RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1310
Mailing Address - Country:US
Mailing Address - Phone:914-964-4000
Mailing Address - Fax:914-964-4044
Practice Address - Street 1:MMG - CROSS COUNTY
Practice Address - Street 2:1010 CENTRAL PARK AVENUE
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704
Practice Address - Country:US
Practice Address - Phone:914-771-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine