Provider Demographics
NPI:1790100626
Name:BASAK, RATNA B (MD)
Entity Type:Individual
Prefix:
First Name:RATNA
Middle Name:B
Last Name:BASAK
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 NICOLLS RD
Mailing Address - Street 2:LEVEL 11
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-7884
Mailing Address - Fax:631-444-8968
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:LEVEL 11
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-7884
Practice Address - Fax:631-444-8968
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-01
Last Update Date:2016-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY276440208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics