Provider Demographics
NPI:1447357058
Name:BACH, JANICE E (MD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:BACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 EAST ADAMS ST
Mailing Address - Street 2:4TH FL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2576
Mailing Address - Country:US
Mailing Address - Phone:315-464-5831
Mailing Address - Fax:315-464-2030
Practice Address - Street 1:725 EAST ADAMS ST
Practice Address - Street 2:4TH FL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2576
Practice Address - Country:US
Practice Address - Phone:315-464-5831
Practice Address - Fax:315-464-2030
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY227324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02424591Medicaid