Basic Information
| Provider Information | |||||||||
| NPI: | 1144249996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASLER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755892 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755892 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 012733 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | MDG697 | 01 | NY | PREFERRED CARE | OTHER | P010012733 | 01 | NY | BLUE CHOICE | OTHER | 000912088002 | 01 | NY | BS WNY/HEALTHNOW | OTHER | 7091312 | 01 | NY | AETNA | OTHER | 02074679 | 05 | NY | MEDICAID | 2222 | 01 | NY | BLUE SHIELD GROUP | OTHER | 680015473 | 01 | NY | RAILROAD MEDICARE | OTHER | 00040602101 | 01 | NY | UNIVERA | OTHER | G0180921590 | 01 | NY | BLUE CHOICE GROUP | OTHER |