| Doctor Name: | DR. LEONID BASOVICH |
| NPI Number: | 1285626515 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD, DO, DAOBFP |
| License Number: | 235997 |
| Business Practice Address: | 565 Route 25a Ste 101 Miller Place, NY - 117642600 |
| Business Phone Number: | 6318494551 |
| Business Fax Number: | 6318494552 |
| Mailing Address: | 565 Route 25a, MILLER PLACE |
| State: | NY |
| Postal Code: | 117642663 |
| Phone Number: | 6318494551 |
| Fax Number: | 6318494552 |
| NPI Enumeration Date: | 08/23/2005 |
| NPI Last Update Date: | 02/11/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | 235997 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |