Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 25MA1057100 | NJ |
NPI | 1013008556 |
---|---|
Provider Name | Dr. Richard V Buonocore |
First Address | Bridgewater, NJ 08807-2943 |
Second Address | Bridgewater, NJ 08807-2943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H24573 | (02) | PA |