Provider Demographics
NPI:1134116072
Name:BASS, JOEL S (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:S
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411N FLAGLER DR 5300
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3415
Mailing Address - Country:US
Mailing Address - Phone:561-833-5594
Mailing Address - Fax:561-833-0017
Practice Address - Street 1:1226 E WATER ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1155
Practice Address - Country:US
Practice Address - Phone:315-478-4185
Practice Address - Fax:315-478-0840
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181895208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01184610Medicaid
NYE86253Medicare UPIN
40012FMedicare ID - Type Unspecified