Healthcare Provider Details

I. General information

NPI: 1427309210
Provider Name (Legal Business Name): ERIC JUSTIN BUXBAUM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE BOX 93
VINELAND NJ
08360-6912
US

IV. Provider business mailing address

1505 W SHERMAN AVE BOX 93
VINELAND NJ
08360-6912
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-8661
  • Fax: 856-575-4944
Mailing address:
  • Phone: 856-641-8661
  • Fax: 856-575-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MB10384100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: