Individual
DR. IRINA BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15-01 BROADWAY, SUITE36, FAIR LAWN, NJ 07410-6003
(201) 773-6171
(201) 773-4845
Mailing address
15-01 BROADWAY STE 36, FAIR LAWN, NJ 07410-6006
(201) 773-6171
(201) 773-4845
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA07639000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0081787
—
NJ
Enumeration date
02/06/2006
Last updated
07/08/2007
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