Healthcare Provider Details

I. General information

NPI: 1497829469
Provider Name (Legal Business Name): GUY ANDREW BUONINCONTRO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GUY A BUONINCONTRO D.O,

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ROUTE 72 EAST
NEW LISBON NJ
08064-0130
US

IV. Provider business mailing address

11 PENDLETON DR
CHERRY HILL NJ
08003-1919
US

V. Phone/Fax

Practice location:
  • Phone: 609-726-1000
  • Fax: 609-726-1387
Mailing address:
  • Phone: 856-424-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB24073
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB02407300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: