MEDICARE: TONUCA BASU PHYSICIANS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	209562	NY

General Provider Information

NPI Number	:	1013206853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TONUCA BASU PHYSICIANS PC

Provider Business Mailing Address
First Line	:	8116 LEFFERTS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1729
Country	:	US
Telephone Number	:	718-850-4370
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1716
Country	:	US
Telephone Number	:	718-757-2069
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TONUCA BASU
Credential	:	M.D.
Telephone Number	:	718-757-2069

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	09/29/2011

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