Provider Demographics
NPI:1942220298
Name:BAUCH, JEAN (RD,CDE)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:BAUCH
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 LEE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4257
Mailing Address - Country:US
Mailing Address - Phone:585-254-4152
Mailing Address - Fax:
Practice Address - Street 1:687 LEE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4257
Practice Address - Country:US
Practice Address - Phone:585-254-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001589133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
P46164Medicare UPIN
DD1812Medicare ID - Type Unspecified