1053396572 NPI number — DR. PATRICK BASU M.D.

Table of content: DR. PATRICK BASU M.D. (NPI 1053396572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053396572 NPI number — DR. PATRICK BASU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASU
Provider First Name:
PATRICK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053396572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9534 WICKHAM WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32836-5524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-226-0284
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6735 CONROY RD STE 223
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32835-3570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-203-2377
Provider Business Practice Location Address Fax Number:
407-203-8811
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  51337 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 190318 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RT0003X , with the licence number: ME135670 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: ME135670 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0008X , with the licence number: ME135670 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0008X , with the licence number: 190318 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 166115 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 218509 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2499388 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5044440 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: HEALTH NET . This is a "4C2929" identifier . This identifiers is of the category "OTHER".
  • Identifier: 693723 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76220 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 190318A33 . This is a "HEALTH FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60H103 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 111517 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1424916 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P627420 . This is a "OXFORD HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09659P . This is a "HIP OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112421400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com