Healthcare Provider Details

I. General information

NPI: 1235257684
Provider Name (Legal Business Name): BASSAM MASSABNY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOBART STREET
PERTH AMBOY NJ
08861
US

IV. Provider business mailing address

275 HOBART ST
PERTH AMBOY NJ
08861-3396
US

V. Phone/Fax

Practice location:
  • Phone: 732-376-9333
  • Fax: 732-324-5765
Mailing address:
  • Phone: 732-376-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02129600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21296
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: