=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255916763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSEMARY M BUONOCORE APN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2021
-----------------------------------------------------
Last Update Date | 03/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 REGENT ST STE 509
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-1682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-251-2437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 REGENT ST STE 509
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-1682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-251-2437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083B0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number | 1649723743
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------