Bassam Taher Kashlan, MD
Individual provider Active NPI Surgery Physician · Wall, NJ
NPI 1093817637 · NPPES record last updated Oct 15, 2007
Key facts
- NPI
- 1093817637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 25MA03019500 (NJ)
- Practice address
- 1540 State Route 138
Suite 201
Wall, NJ 07719-3763 - Phone
- (732) 280-0020
- Fax
- (732) 681-0261
- NPI assigned
- Sep 3, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 25MA03019500 | NJ | Yes |
Addresses
Primary practice location
1540 State Route 138
Suite 201
Wall, NJ 07719-3763
Mailing address
1540 State Route 138
Suite 201
Wall, NJ 07719-3763
Phone (732) 280-0020
Other providers in Wall, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.