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Individual

DR. JAIME A BASTIDAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
244 ROSEBERRY ST., SUITE #5, PHILLIPSBURG, NJ 08865
(908) 454-1704
(908) 454-1706
Mailing address
244 ROSEBERRY ST., SUITE #5, PHILLIPSBURG, NJ 08865
(908) 454-1704
(908) 454-1706

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
25MA07689900
NJ
174400000X
Specialist
MD422370
PA
2086S0122X
Plastic and Reconstructive Surgery Physician
25MA07689900
NJ
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD422370
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
073750
MEDICARE PTAN
PA
01
074448UK1
MEDICARE PTAN
NJ
01
074448ZH1E
MEDICARE PTAN
NJ
Enumeration date
09/02/2006
Last updated
08/07/2015
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