Healthcare Provider Details

I. General information

NPI: 1114921848
Provider Name (Legal Business Name): IRA NEIL BACHMAN MD,FACOG
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 CENTRAL AVE
CEDARHURST NY
11516-2303
US

IV. Provider business mailing address

660 CENTRAL AVE
CEDARHURST NY
11516-2303
US

V. Phone/Fax

Practice location:
  • Phone: 516-374-1777
  • Fax: 516-295-9245
Mailing address:
  • Phone: 516-374-1777
  • Fax: 516-295-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number192114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: