Organization
KIDKARE MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRINA BASS MD (PEDIATRICIAN)
(201) 773-6171
Entity
Organization
Contact information
Practice address
15-01 BROADWAY STE 36, FAIR LAWN, NJ 07410-6006
(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
261Q00000X
Clinic/Center
Primary
25MA07639000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0081787
—
NJ
01
—
1346212156
INDIVIDUAL NPI
NJ
Enumeration date
05/04/2007
Last updated
06/23/2016
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