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General NPI Number Information
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NPI Number | 1144416058
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Entity Type | Individual
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Provider Name | JONATHAN N BACHARACH DPT
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Gender | Male
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 897 BROADWAY LOWER LEVEL
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City | NEW YORK
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State | NY
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Zip | 10003-1205
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Country | US
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Telephone | 212-673-7878
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Fax | 212-674-7878
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Provider Business Mailing Address
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Address Line | 6319 FLY RD SUITE 3
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9326
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Country | US
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Telephone | 315-410-6200
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Fax | 315-451-2095
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 029697-1
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License Number State | NY
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