Provider Demographics
NPI:1356499768
Name:DELRAN INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:DELRAN INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:BASARA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-764-2525
Mailing Address - Street 1:5045 RTE 130 S
Mailing Address - Street 2:STE E
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-9707
Mailing Address - Country:US
Mailing Address - Phone:856-764-2525
Mailing Address - Fax:856-764-6344
Practice Address - Street 1:5045 RTE 130 S
Practice Address - Street 2:STE E
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9707
Practice Address - Country:US
Practice Address - Phone:856-764-2525
Practice Address - Fax:856-764-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57034207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E96013Medicare UPIN
NJ684338NTRMedicare ID - Type Unspecified