Healthcare Provider Details

I. General information

NPI: 1184811192
Provider Name (Legal Business Name): ELLIOT L BASS DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2381 E 29TH ST
BROOKLYN NY
11229-5027
US

IV. Provider business mailing address

38 LARCH HILL RD
LAWRENCE NY
11559-1926
US

V. Phone/Fax

Practice location:
  • Phone: 718-743-1400
  • Fax: 718-743-7003
Mailing address:
  • Phone: 718-743-1400
  • Fax: 718-743-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLIOT L BASS
Title or Position: PRES.
Credential: DPM
Phone: 718-743-1400