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General NPI Number Information
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NPI Number | 1689270803
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Entity Type | Organization
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Legal Business Name | BASTION HEALTH INC
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 115 N CALHOUN ST STE 4
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1568
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Country | US
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Telephone | 617-678-3881
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Fax |
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Provider Business Mailing Address
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Address Line | 400 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-1913
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Country | US
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Telephone | 860-245-1670
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | REZA AMIN
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Credential |
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Telephone | 860-245-1670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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