Provider Demographics
NPI:1588875603
Name:BASU, ELLEN M (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:BASU
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1275 YORK AVE # 139
Mailing Address - Street 2:MSKCC, DEPT OF PEDIATRICS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-5945
Mailing Address - Fax:212-717-3447
Practice Address - Street 1:1275 YORK AVE # 139
Practice Address - Street 2:MSKCC, DEPT OF PEDIATRICS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-5945
Practice Address - Fax:212-717-3447
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-08-02
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Provider Licenses
StateLicense IDTaxonomies
NY2578332080P0207X
MA241049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics