Basic Information
| Provider Information | |||||||||
| NPI: | 1689734154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASSORA | ||||||||
| FirstName: | ROCCO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 520 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2675926191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 NJ 17 | ||||||||
| Address2: | 11TH STREET | ||||||||
| City: | RUTHERFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886367840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 25MA10235000 | NJ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | 252952 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.