MEDICARE: KRISTA J BASSO PA-C

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	363A00000X	Physician Assistant	25MP00503200	NJ

General Provider Information

NPI Number	:	1700379757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA J BASSO PA-C

Provider Business Mailing Address
First Line	:	PO BOX 306698
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6698
Country	:	US
Telephone Number	:	609-927-1030
Fax Number	:	609-927-9985

Provider Business Practice Location Address
First Line	:	2106 NEW RD STE D8
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1050
Country	:	US
Telephone Number	:	609-927-1030
Fax Number	:	609-927-9985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	04/13/2026

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