Provider Demographics
NPI:1881686517
Name:BAYERBACH, FRANK RALPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:RALPH
Last Name:BAYERBACH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 GREAT EAST NECK RD
Mailing Address - Street 2:
Mailing Address - City:W BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7801
Mailing Address - Country:US
Mailing Address - Phone:631-661-0073
Mailing Address - Fax:631-587-7995
Practice Address - Street 1:229 GREAT EAST NECK RD
Practice Address - Street 2:
Practice Address - City:W BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7801
Practice Address - Country:US
Practice Address - Phone:631-661-0073
Practice Address - Fax:631-587-7995
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2009-09-24
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-18
Provider Licenses
StateLicense IDTaxonomies
NYN004204213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01037094Medicaid
NY01037094Medicaid