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General NPI Number Information
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NPI Number | 1649260563
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Entity Type | Individual
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Provider Name | ALAN L. BASS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 10/22/2005
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 701 TENNENT RD STE 101
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City | MANALAPAN
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State | NJ
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Zip | 07726-3193
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Country | US
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Telephone | 732-866-4411
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Fax | 732-866-0044
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Provider Business Mailing Address
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Address Line | 701 TENNENT RD STE 101
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City | MANALAPAN
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State | NJ
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Zip | 07726-3193
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Country | US
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Telephone | 732-866-4411
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Fax | 732-866-0044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | N005169-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 25MD00231100
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License Number State | NJ
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