Healthcare Provider Details

I. General information

NPI: 1235288820
Provider Name (Legal Business Name): PETER C BUFANO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STATE HWY 34
MATAWAN NJ
07747
US

IV. Provider business mailing address

144 STATE HWY 34
MATAWAN NJ
07747
US

V. Phone/Fax

Practice location:
  • Phone: 732-316-5895
  • Fax: 732-316-5894
Mailing address:
  • Phone: 732-316-5895
  • Fax: 732-316-5894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberMC05472
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: