Provider Demographics
NPI:1952697070
Name:BACHMAN, JODIE ANN (DO)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:ANN
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-377-6700
Mailing Address - Fax:973-377-8008
Practice Address - Street 1:345 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940
Practice Address - Country:US
Practice Address - Phone:973-377-6700
Practice Address - Fax:973-377-8008
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09707800207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine