Provider Demographics
NPI:1497016505
Name:BACH, RENEE ALLISON (MSED)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ALLISON
Last Name:BACH
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CEDARHURST AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1214
Mailing Address - Country:US
Mailing Address - Phone:516-569-2471
Mailing Address - Fax:
Practice Address - Street 1:415 CEDARHURST AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1214
Practice Address - Country:US
Practice Address - Phone:516-569-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist