Provider Demographics
NPI:1437622057
Name:ANTHONY J BACCHI MEDICINE, PLLC
Entity Type:Organization
Organization Name:ANTHONY J BACCHI MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:845-905-6192
Mailing Address - Street 1:2628 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5398
Mailing Address - Country:US
Mailing Address - Phone:845-905-6192
Mailing Address - Fax:
Practice Address - Street 1:2628 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5398
Practice Address - Country:US
Practice Address - Phone:845-905-6192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty