Healthcare Provider Details

I. General information

NPI: 1013919141
Provider Name (Legal Business Name): RICHARD JOSEPH BUKOSKY M D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 N WOOD AVE
LINDEN NJ
07036
US

IV. Provider business mailing address

926 N WOOD AVE
LINDEN NJ
07036
US

V. Phone/Fax

Practice location:
  • Phone: 908-925-3318
  • Fax: 908-925-8646
Mailing address:
  • Phone: 908-925-3318
  • Fax: 908-925-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMA02113000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: