Provider Demographics
NPI:1528157773
Name:BASSAN, MAYER MOSES (MD)
Entity type:Individual
Prefix:DR
First Name:MAYER
Middle Name:MOSES
Last Name:BASSAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11 WINDMILL ST
Mailing Address - Street 2:
Mailing Address - City:JERUSALEM
Mailing Address - State:JERUSALEM
Mailing Address - Zip Code:94110
Mailing Address - Country:IL
Mailing Address - Phone:9722-624-2231
Mailing Address - Fax:9722-624-2231
Practice Address - Street 1:11 WINDMILL ST
Practice Address - Street 2:
Practice Address - City:JERUSALEM
Practice Address - State:JERUSALEM
Practice Address - Zip Code:94110
Practice Address - Country:IL
Practice Address - Phone:9722-624-2231
Practice Address - Fax:9722-624-2231
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG15155207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease