Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 293507 | NY |
Y | 208600000X | Surgeon | 293507 | NY |
N | 2082S0105X | Plastic Hand Surgeon | 293507 | NY |
NPI | 1487943981 |
---|---|
Provider Name | Mr. Jonathan Lee Bass |
First Address | New York, NY 10016-9196 |
Second Address | New York, NY 10016-9196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2011 |
Last Update Date | 23/02/2021 |