Provider Demographics
NPI:1487724183
Name:BASSIL, ADONIS B (PT)
Entity type:Individual
Prefix:MR
First Name:ADONIS
Middle Name:B
Last Name:BASSIL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 STATE RT 33 FIRST FLOOR SUITE 1A
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4800
Mailing Address - Country:US
Mailing Address - Phone:732-517-0700
Mailing Address - Fax:732-517-0702
Practice Address - Street 1:1900 STATE ROUTE 33
Practice Address - Street 2:OMNI CENTER, FIRST FLOOR, SUITE 1A
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4800
Practice Address - Country:US
Practice Address - Phone:732-517-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00657600261QP2000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123606Medicare PIN