Provider Demographics
NPI:1699717017
Name:BASU, TONUCA (MD)
Entity type:Individual
Prefix:
First Name:TONUCA
Middle Name:
Last Name:BASU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1729
Mailing Address - Country:US
Mailing Address - Phone:718-850-4370
Mailing Address - Fax:718-732-1472
Practice Address - Street 1:3440 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1716
Practice Address - Country:US
Practice Address - Phone:718-235-0222
Practice Address - Fax:718-235-1811
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01911417Medicaid
NY2596365OtherGHI
NYP2097880OtherOXFORD
NY4648370OtherAETNA
NYC32598Medicare UPIN
NY01911417Medicaid