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General NPI Number Information
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NPI Number | 1700379757
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Entity Type | Individual
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Provider Name | KRISTA J BASSO PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 2106 NEW RD STE D8
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City | LINWOOD
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State | NJ
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Zip | 08221-1050
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Country | US
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Telephone | 609-927-1030
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Fax | 609-927-9985
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Provider Business Mailing Address
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Address Line | 2106 NEW RD STE D8
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City | LINWOOD
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State | NJ
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Zip | 08221-1050
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Country | US
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Telephone | 609-606-1935
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Fax | 609-927-9985
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 25MP00503200
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License Number State | NJ
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