Healthcare Provider Details

I. General information

NPI: 1952697070
Provider Name (Legal Business Name): JODIE ANN BACHMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MAIN STREET
MADISON NJ
07940
US

IV. Provider business mailing address

345 MAIN STREET
MADISON NJ
07940
US

V. Phone/Fax

Practice location:
  • Phone: 973-377-6700
  • Fax: 973-377-8008
Mailing address:
  • Phone: 973-377-6700
  • Fax: 973-377-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number25MB09707800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: