Provider Demographics
NPI:1205863438
Name:BASTI, JOHN JUDE (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JUDE
Last Name:BASTI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PROGRESS ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1180
Mailing Address - Country:US
Mailing Address - Phone:908-222-9696
Mailing Address - Fax:908-222-9698
Practice Address - Street 1:3 PROGRESS ST
Practice Address - Street 2:SUITE 107
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1180
Practice Address - Country:US
Practice Address - Phone:908-222-9696
Practice Address - Fax:908-222-9698
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA02804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ473866Medicare ID - Type Unspecified