Provider Demographics
NPI:1427249978
Name:BAUER, JOHN JOSEPH SR
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:BAUER
Suffix:SR
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 1:146 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:DOVER PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12522-6057
Mailing Address - Country:US
Mailing Address - Phone:845-797-2250
Mailing Address - Fax:
Practice Address - Street 1:21 HARVEST DR
Practice Address - Street 2:NONA MALAGUIT
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10609-3705
Practice Address - Country:US
Practice Address - Phone:845-893-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2544001164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01826599Medicaid