Ronald G. Basalyga, M.D. PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

095710 Issued in NY

Legal business name

RONALD G. BASALYGA, M.D. PC

Practice address

4711 Pinecrest Ter
Eden, NY 14057-9757

Phone

(716) 649-5188

Fax

(716) 649-5188

NPI assigned

Jul 30, 2007

Organization subpart

No

Name

Dr. Ronald G. Basalyga

Title

President

Phone

(716) 649-5188

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 30, 2007.

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1053501700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 PINECREST TER",
            "city": "EDEN",
            "state": "NY",
            "postal_code": "140579757",
            "telephone_number": "716-649-5188",
            "fax_number": "716-649-5188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 PINECREST TER",
            "city": "EDEN",
            "state": "NY",
            "postal_code": "140579757",
            "telephone_number": "716-649-5188",
            "fax_number": "716-649-5188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD G. BASALYGA, M.D. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "BASALYGA",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-649-5188",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "095710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD NPI #",
            "identifier": "1225240609",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO",
            "identifier": "2308442",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00591846",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD-MEDICARE ID #",
            "identifier": "DD3550",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO",
            "identifier": "00010011502",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PC MEDICARE ID #",
            "identifier": "AA1447",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.