Provider Demographics
NPI:1013952431
Name:BASAK, JHARNA (MD)
Entity Type:Individual
Prefix:
First Name:JHARNA
Middle Name:
Last Name:BASAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 CAZENOVIA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2450
Mailing Address - Country:US
Mailing Address - Phone:716-823-3462
Mailing Address - Fax:716-823-9397
Practice Address - Street 1:187 CAZENOVIA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2450
Practice Address - Country:US
Practice Address - Phone:716-823-3462
Practice Address - Fax:716-823-9397
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145614207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6490002OtherINDEPENDENT HEALTH ASSOC.
NY00010200501OtherUNIVERA
NY6490002OtherINDEPENDENT HEALTH ASSOC.
NY002861Medicare ID - Type Unspecified