Healthcare Provider Details

I. General information

NPI: 1477867562
Provider Name (Legal Business Name): RICHARD M. BACHRACH D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 MADISON AVE SUITE 400
NEW YORK NY
10017-5201
US

IV. Provider business mailing address

317 MADISON AVE SUITE 400
NEW YORK NY
10017-5201
US

V. Phone/Fax

Practice location:
  • Phone: 212-685-8113
  • Fax: 212-697-4541
Mailing address:
  • Phone: 212-685-8113
  • Fax: 212-697-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number076496
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number239708
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number255844
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number148023
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID J ISTVAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 212-685-8113