Provider Demographics
NPI:1063261329
Name:BACHISIN, PARKER ROBERT
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:ROBERT
Last Name:BACHISIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MANORAGE RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3318
Mailing Address - Country:US
Mailing Address - Phone:631-508-6866
Mailing Address - Fax:
Practice Address - Street 1:607 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3362
Practice Address - Country:US
Practice Address - Phone:631-732-3900
Practice Address - Fax:631-732-3908
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0818709208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation