MEDICARE: JASJIT BASRA DDS 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1922953876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASJIT BASRA DDS PC

Provider Business Mailing Address
First Line	:	430 E 20TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-8201
Country	:	US
Telephone Number	:	212-473-4151
Fax Number	:	646-414-2004

Provider Business Practice Location Address
First Line	:	430 E 20TH ST APT MH
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-8202
Country	:	US
Telephone Number	:	212-473-4151
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASJIT BASRA
Credential	:	DDS
Telephone Number	:	518-435-5304

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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