Provider Demographics
NPI:1295562247
Name:BACHARACH, BENJI
Entity type:Individual
Prefix:
First Name:BENJI
Middle Name:
Last Name:BACHARACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:BACHARACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7 E 14TH ST APT 429
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3130
Mailing Address - Country:US
Mailing Address - Phone:267-234-8134
Mailing Address - Fax:
Practice Address - Street 1:16 E 41ST ST UNIT 5C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6217
Practice Address - Country:US
Practice Address - Phone:267-289-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health