Healthcare Provider Details

I. General information

NPI: 1942220298
Provider Name (Legal Business Name): JEAN BAUCH RD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 LEE RD SUITE 160
ROCHESTER NY
14606-4257
US

IV. Provider business mailing address

687 LEE RD SUITE 160
ROCHESTER NY
14606-4257
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-4152
  • Fax:
Mailing address:
  • Phone: 585-254-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number001589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: