Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MA02113000 | NJ |
NPI | 1013919141 |
---|---|
Provider Name | Dr. Richard Joseph Bukosky |
First Address | Linden, NJ 07036 |
Second Address | Linden, NJ 07036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 12/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0150142000 | AMERIHEALTH (01) | NJ |
2895102 | (05) | NJ |
2K0824 | HEALTHNET (01) | |
8828709 | (05) | NJ |
C61648 | (02) | |
US133 | OXFORD (01) |