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NPI Code Detail

MEDICARE: JOEL S BASS M.D.

MEDICARE: JOEL S BASS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician181895NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134116072
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL S BASS M.D.
Provider Business Mailing Address
First Line : 1411N FLAGLER DR 5300
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33401-3415
Country : US
Telephone Number : 561-833-5594
Fax Number : 561-833-0017
Provider Business Practice Location Address
First Line : 1226 E WATER ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-1155
Country : US
Telephone Number : 315-478-4185
Fax Number : 315-478-0840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 11/12/2015

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