Provider Demographics
NPI:1740396308
Name:FASS, BARRY D (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:D
Last Name:FASS
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 1:2103 WHITEHORSE-MERCERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610
Mailing Address - Country:US
Mailing Address - Phone:609-890-2222
Mailing Address - Fax:609-890-0715
Practice Address - Street 1:2103 WHITEHORSE-MERCERVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610
Practice Address - Country:US
Practice Address - Phone:609-890-2222
Practice Address - Fax:609-890-0715
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06543500208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ017940R50Medicare ID - Type Unspecified
B42154Medicare UPIN