Healthcare Provider Details

I. General information

NPI: 1235248303
Provider Name (Legal Business Name): BASIL A KOCUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 WHITE PLAINS RD SUITE 221
SCARSDALE NY
10583-5059
US

IV. Provider business mailing address

2 OVERHILL RD
SCARSDALE NY
10583-5323
US

V. Phone/Fax

Practice location:
  • Phone: 914-722-2600
  • Fax:
Mailing address:
  • Phone: 914-722-2600
  • Fax: 914-719-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number179608
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: