Healthcare Provider Details

I. General information

NPI: 1295707636
Provider Name (Legal Business Name): IBRAHIM SALEM BUKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD BLDG 6 SUITE 85
HAZLET NJ
07730-1669
US

IV. Provider business mailing address

4 GREEN LEAF WAY
HOLMDEL NJ
07733-1048
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-7208
  • Fax:
Mailing address:
  • Phone: 732-264-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA03741400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: