MEDICARE: DR. JON L BASS MD

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
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	25MA077515000	NJ
2	207RP1001X	Pulmonary Disease Physician	25MA077515000	NJ

General Provider Information

NPI Number	:	1407857659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON L BASS MD

Provider Business Mailing Address
First Line	:	1 DIAMOND HILL RD
Second Line	:	SUMMIT MEDICAL GROUP
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-2104
Country	:	US
Telephone Number	:	908-273-4300
Fax Number	:	908-277-8927

Provider Business Practice Location Address
First Line	:	1 DIAMOND HILL RD
Second Line	:	SUMMIT MEDICAL GROUP
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-2104
Country	:	US
Telephone Number	:	908-277-8674
Fax Number	:	908-277-8927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/23/2019

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