Individual
GURBHUSHAN SINGH BASRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 SAINT ANDREWS LN, GLEN COVE, NY 11542-2254
(516) 674-7540
Mailing address
3 BRANDING IRON LN, GLEN COVE, NY 11542-1619
(516) 671-2686
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
159751-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00847461
—
NY
Enumeration date
10/17/2006
Last updated
07/08/2007
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