Healthcare Provider Details

I. General information

NPI: 1104841154
Provider Name (Legal Business Name): NANCY BUCKHOLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BOOKER STREET
WESTWOOD NJ
07675-2619
US

IV. Provider business mailing address

24 BOOKER STREET
WESTWOOD NJ
07675-2619
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-0100
  • Fax: 201-822-0107
Mailing address:
  • Phone: 201-822-0100
  • Fax: 201-822-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA00518500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: