Provider Demographics
NPI:1508936428
Name:BACHRACH, STACEY R (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:R
Last Name:BACHRACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 WESCOTT DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4677
Mailing Address - Country:US
Mailing Address - Phone:908-237-6910
Mailing Address - Fax:908-948-1046
Practice Address - Street 1:9100 WESCOTT DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4677
Practice Address - Country:US
Practice Address - Phone:908-237-6910
Practice Address - Fax:908-948-1046
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40973208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080160213OtherRAILROAD MEDICARE #
NJ080160213OtherRAILROAD MEDICARE #
NJBA520453PANMedicare PIN