Provider Demographics
NPI:1093817637
Name:KASHLAN, BASSAM TAHER (MD)
Entity Type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:TAHER
Last Name:KASHLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 STATE ROUTE 138
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3763
Mailing Address - Country:US
Mailing Address - Phone:732-280-0020
Mailing Address - Fax:732-681-0261
Practice Address - Street 1:1540 STATE ROUTE 138
Practice Address - Street 2:SUITE 201
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3763
Practice Address - Country:US
Practice Address - Phone:732-280-0020
Practice Address - Fax:732-681-0261
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03019500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06980Medicare UPIN
NJ445038Medicare PIN