Healthcare Provider Details

I. General information

NPI: 1902717739
Provider Name (Legal Business Name): LAURA BUKOSKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SCHANCK RD BLDG D
FREEHOLD NJ
07728-2964
US

IV. Provider business mailing address

55 SCHANCK RD BLDG D
FREEHOLD NJ
07728-2964
US

V. Phone/Fax

Practice location:
  • Phone: 732-820-9610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number938552
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: