Healthcare Provider Details

I. General information

NPI: 1215849559
Provider Name (Legal Business Name): FABIAN BUENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 ROUTE 37 W
TOMS RIVER NJ
08755
US

IV. Provider business mailing address

233 W 4TH AVE 233 W 4TH AVE
ROSELLE NJ
07203-1135
US

V. Phone/Fax

Practice location:
  • Phone: 732-234-0058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00193100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: