Provider Demographics
NPI:1184811192
Name:ELLIOT L BASS DPM, PC
Entity type:Organization
Organization Name:ELLIOT L BASS DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-743-1400
Mailing Address - Street 1:38 LARCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1926
Mailing Address - Country:US
Mailing Address - Phone:718-743-1400
Mailing Address - Fax:718-743-7003
Practice Address - Street 1:2381 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5027
Practice Address - Country:US
Practice Address - Phone:718-743-1400
Practice Address - Fax:718-743-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528061082OtherNPI
P469339OtherOXFORD
1548241979OtherNPI
NY00403503Medicaid
0017805OtherGHI
NY01578803Medicaid
2030683OtherUNITED HEALTHCARE
6201069OtherGHI
NY00403503Medicaid