Provider Demographics
NPI:1700379757
Name:BASSO, KRISTA J (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:J
Last Name:BASSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 NEW RD STE D8
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1050
Mailing Address - Country:US
Mailing Address - Phone:609-606-1935
Mailing Address - Fax:609-927-9985
Practice Address - Street 1:2106 NEW RD STE D8
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1050
Practice Address - Country:US
Practice Address - Phone:609-927-1030
Practice Address - Fax:609-927-9985
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP00503200364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant