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Individual
DIANA BAST
Active
Individual
DIANA BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
25MP00181700
NJ
363AS0400X
Surgical Physician Assistant
Primary
MA057632
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140042NMS
MEDICARE PTAN
NJ
Enumeration date
09/11/2007
Last updated
05/31/2016
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