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General NPI Number Information
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NPI Number | 1689840787
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Entity Type | Organization
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Legal Business Name | LEWIS BASS DO PC
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 58 50 CATALPA AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5032
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Country | US
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Telephone | 718-821-1969
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Fax | 718-821-1125
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Provider Business Mailing Address
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Address Line | 31 PEACOCK DR
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City | ROSLYN
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State | NY
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Zip | 11576-2522
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Country | US
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Telephone | 516-625-1944
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Fax | 516-626-6680
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEWIS BASS
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Credential | MD
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Telephone | 516-625-1944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 124814
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 124814
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License Number State | NY
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