MEDICARE: CLIFFORD WAYNE BASSETT MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	1692761	NJ

General Provider Information

NPI Number	:	1154348589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD WAYNE BASSETT MD, PC

Provider Business Mailing Address
First Line	:	381 PARK AVE S
Second Line	:	SUITE 1020
City	:	NEW YORK
State	:	NY
Zip	:	10016-8806
Country	:	US
Telephone Number	:	212-260-6078
Fax Number	:	212-260-6185

Provider Business Practice Location Address
First Line	:	381 PARK AVE S
Second Line	:	SUITE 1020
City	:	NEW YORK
State	:	NY
Zip	:	10016-8806
Country	:	US
Telephone Number	:	212-260-6078
Fax Number	:	212-260-6185

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLIFFORD WAYNE BASSETT
Credential	:	MD
Telephone Number	:	212-260-6078

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/22/2014

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