# LEONID BASOVICH, DO, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Leonid Basovich, DO, PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366644106
- **Authorized official:** DR. LEONID BASOVICH DO (PRESIDENT)
- **Authorized official phone:** (516) 884-2349

## Contact information

- **Practice address:** 565 ROUTE 25A STE 101, MILLER PLACE, NY 11764-2600
- **Practice address phone:** (631) 849-4551
- **Practice address fax:** (631) 849-4552
- **Mailing address:** 4232 SPRING LN, FAIR OAKS, CA 95628-7089
- **Mailing address phone:** (516) 884-2349

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 235997 | NY | — |
| 207Q00000X | Family Medicine Physician | 235997 | NY | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | 235997 | NY | — |

## Other

- **Enumeration date:** 06/04/2007
- **Last updated:** 06/04/2020