Provider Demographics
NPI:1336308873
Name:BAUER, ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:532 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 142
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3672
Mailing Address - Country:US
Mailing Address - Phone:516-931-0041
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DR
Practice Address - Street 2:SUITE 10
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1965
Practice Address - Country:US
Practice Address - Phone:845-354-5000
Practice Address - Fax:845-354-9469
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2012-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY256090208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400030839Medicare PIN