=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285217596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VAIDEHI BUCH NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2021
-----------------------------------------------------
Last Update Date | 09/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 W 45TH ST FL 11
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-849-4146
-----------------------------------------------------
Fax | 646-849-5096
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 10TH AVE APT 13F
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-7047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-717-7784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95017239
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 348460
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------