Provider Demographics
NPI:1154540037
Name:BASANTE, JOSEPH R (MA,MS,OTR,CHT,CEAS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:BASANTE
Suffix:
Gender:M
Credentials:MA,MS,OTR,CHT,CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 SANDHILL DR
Practice Address - Street 2:SUITE 103, KETLAY PLAZA
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5805
Practice Address - Country:US
Practice Address - Phone:302-285-0700
Practice Address - Fax:302-285-0701
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00208700225XH1200X
DEU1-0001183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087731Medicare PIN
DE375370Y0XMedicare PIN