MEDICARE: SUSAN E BACH FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F336098	NY
2	363LW0102X	Women's Health Nurse Practitioner	F420616	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00246624	OTHER	NY	MEDICARE RAILROAD LEGACY#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9513196	OTHER		IHA LEGACY #

General Provider Information

NPI Number	:	1124086707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E BACH FNP-C

Provider Business Mailing Address
First Line	:	3435 MAIN ST
Second Line	:	HEALTH SERIVES MICHAEL HALL
City	:	BUFFALO
State	:	NY
Zip	:	14214-3001
Country	:	US
Telephone Number	:	716-829-3316
Fax Number	:	716-829-2564

Provider Business Practice Location Address
First Line	:	3435 MAIN ST
Second Line	:	HEALTH SERVICES MICHAEL HALL
City	:	BUFFALO
State	:	NY
Zip	:	14214-3001
Country	:	US
Telephone Number	:	716-829-3316
Fax Number	:	716-829-2564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/07/2011

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Directions to “ SUSAN E BACH FNP-C” Practice Location

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