Dr. Jack Bastow, DPM
in Albany, NY. Individual provider (NPI-1).
NPI number1881621423
StatusActive
Last updated in NPPESJan 22, 2009
Details
- NPI
- 1881621423
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jack Bastow
- Credential
- DPM
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 27, 2006
- Last updated
- Jan 22, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 213ES0131X | 003886 | NY | Yes |
Practice location
4 Palisades DrSuite 250a
Albany, NY 12205-1443
Phone 518-458-1771 · Fax 518-459-7682
Mailing address
4 Palisades DrSuite 250a
Albany, NY 12205-1443
Phone 518-458-1771 · Fax 518-459-7682
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