Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 239287-1 | NY |
NPI | 1043258486 |
---|---|
Provider Name | Victor John Bucalo |
First Address | Englewood, NJ 07631-4967 |
Second Address | Englewood, NJ 07631-4967 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 13/06/2008 |