Provider Demographics
NPI:1790479947
Name:BACH, BENJAMIN DANIEL
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:BACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2116
Mailing Address - Country:US
Mailing Address - Phone:412-779-9076
Mailing Address - Fax:
Practice Address - Street 1:500 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2801
Practice Address - Country:US
Practice Address - Phone:412-675-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator