Provider Demographics
NPI:1649535907
Name:BASS, DANIELLE
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:NOUJAIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 W 60TH ST
Mailing Address - Street 2:APT 9R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7497
Mailing Address - Country:US
Mailing Address - Phone:914-471-2141
Mailing Address - Fax:
Practice Address - Street 1:37-11 35TH AVENUE
Practice Address - Street 2:SUITE 3C
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-706-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program