Provider Demographics
NPI:1215756705
Name:SUPARNA BASU MD PC
Entity type:Organization
Organization Name:SUPARNA BASU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SUPARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-232-5732
Mailing Address - Street 1:2609 SUNNY MDWS
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-4054
Mailing Address - Country:US
Mailing Address - Phone:516-232-5732
Mailing Address - Fax:
Practice Address - Street 1:40886 GOODWIN WAY
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-9900
Practice Address - Country:US
Practice Address - Phone:516-232-5732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital