Individual
DR. JACK BASTOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4 PALISADES DR, SUITE 250A, ALBANY, NY 12205-1443
(518) 458-1771
(518) 459-7682
Mailing address
4 PALISADES DR, SUITE 250A, ALBANY, NY 12205-1443
(518) 458-1771
(518) 459-7682
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
003886
NY
Other
Enumeration date
06/27/2006
Last updated
01/22/2009
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