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General NPI Number Information
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NPI Number | 1336655851
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Entity Type | Individual
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Provider Name | MR. JEFFRY THOMAS BUCYK
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Gender | Male
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 225 CANAL ST
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City | SALEM
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State | MA
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Zip | 01970-4554
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Country | US
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Telephone | 978-542-2879
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Fax |
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Provider Business Mailing Address
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Address Line | 95 AMESBURY RD
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City | NEWTON
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State | NH
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Zip | 03858-3205
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Country | US
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Telephone | 603-819-3423
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 390200000X
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License Number State | MA
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