Provider Demographics
NPI:1144249996
Name:BASLER, STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:BASLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5892
Mailing Address - Fax:585-756-0169
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5892
Practice Address - Fax:585-756-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12733103T00000X
NY012733103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02074679Medicaid
NYG0180921590OtherBLUE CHOICE GROUP
NY000912088002OtherBS WNY/HEALTHNOW
NYP010012733OtherBLUE CHOICE
NY00040602101OtherUNIVERA
NY7091312OtherAETNA
NY2222OtherBLUE SHIELD GROUP
NY680015473OtherRAILROAD MEDICARE
NYMDG697OtherPREFERRED CARE
NY000912088002OtherBS WNY/HEALTHNOW
NYCC8355Medicare ID - Type UnspecifiedMEDICARE