Provider Demographics
NPI:1760437768
Name:BAUER, ULRICH (M D)
Entity Type:Individual
Prefix:DR
First Name:ULRICH
Middle Name:
Last Name:BAUER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 AVERY COURT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08813
Mailing Address - Country:US
Mailing Address - Phone:716-864-2149
Mailing Address - Fax:
Practice Address - Street 1:546 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3312
Practice Address - Country:US
Practice Address - Phone:908-232-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082510002080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8828709Medicaid
NJ0150142000OtherAMERIHEALTH
NY00599564Medicaid
NJ0150142000OtherAMERIHEALTH
NJ8828709Medicaid
NY00599564Medicaid