Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MA04418200 | NJ |
NPI | 1013904853 |
---|---|
Provider Name | Mr. Patrick M Buddle |
First Address | Sea Girt, NJ 08750-2805 |
Second Address | Sea Girt, NJ 08750-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3919706 | (05) | NJ |
C59656 | (02) |