=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184811192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELLIOT L BASS DPM, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 07/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2381 E 29TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-5027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-743-1400
-----------------------------------------------------
Fax | 718-743-7003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 LARCH HILL RD
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11559-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-743-1400
-----------------------------------------------------
Fax | 718-743-7003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES.
-----------------------------------------------------
Name | DR. ELLIOT L BASS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 718-743-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------