Provider Demographics
NPI:1205911385
Name:BASNER, ROBERT CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:BASNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:622 WEST 168TH ST
Mailing Address - Street 2:PH859
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-7591
Mailing Address - Fax:212-342-4784
Practice Address - Street 1:622 WEST 168TH ST
Practice Address - Street 2:PH859
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-7591
Practice Address - Fax:212-342-4784
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY215968207RP1001X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02008620Medicaid
NYE52430Medicare UPIN
NY02008620Medicaid