Provider Demographics
NPI:1154348589
Name:CLIFFORD WAYNE BASSETT MD, PC
Entity type:Organization
Organization Name:CLIFFORD WAYNE BASSETT MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-260-6078
Mailing Address - Street 1:381 PARK AVE S
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8806
Mailing Address - Country:US
Mailing Address - Phone:212-260-6078
Mailing Address - Fax:212-260-6185
Practice Address - Street 1:381 PARK AVE S
Practice Address - Street 2:SUITE 1020
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8806
Practice Address - Country:US
Practice Address - Phone:212-260-6078
Practice Address - Fax:212-260-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1692761207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty