MEDICARE: TONUCA BASU M.D.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2596365	OTHER	NY	GHI
3	P2097880	OTHER	NY	OXFORD
4	4648370	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1699717017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONUCA BASU M.D.

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	:	718-732-1472

Provider Business Practice Location Address
First Line	:	3440 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1716
Country	:	US
Telephone Number	:	718-235-0222
Fax Number	:	718-235-1811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	11/25/2016

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