Provider Demographics
NPI:1093128167
Name:BASTIA, BIENNE
Entity Type:Individual
Prefix:
First Name:BIENNE
Middle Name:
Last Name:BASTIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1003
Mailing Address - Country:US
Mailing Address - Phone:484-468-1493
Mailing Address - Fax:888-910-7765
Practice Address - Street 1:3222 W CHELTENHAM AVE STE B-1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1003
Practice Address - Country:US
Practice Address - Phone:484-468-1493
Practice Address - Fax:888-910-7765
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA24693601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health