Provider Demographics
NPI:1912943812
Name:HERBERT, BASYA V (MD)
Entity Type:Individual
Prefix:DR
First Name:BASYA
Middle Name:V
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BASYA
Other - Middle Name:
Other - Last Name:VEYBERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:360 EAST AVE STE 3
Mailing Address - Street 2:HUTHER HEALTH CLINIC
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2638
Mailing Address - Country:US
Mailing Address - Phone:585-325-5100
Mailing Address - Fax:585-232-1275
Practice Address - Street 1:360 EAST AVE STE 3
Practice Address - Street 2:HUTHER HEALTH CLINIC
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2638
Practice Address - Country:US
Practice Address - Phone:585-325-5100
Practice Address - Fax:585-232-1275
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4746Medicare PIN
NYI 19775Medicare UPIN