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General NPI Number Information
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NPI Number | 1558971358
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Entity Type | Individual
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Provider Name | KIRSTEN LANE BUCKLEY APN
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Gender | Female
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 9 S MAIN ST
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City | MARLBORO
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State | NJ
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Zip | 07746-1539
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Country | US
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Telephone | 732-744-4332
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 ROBIN WAY
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City | MANASQUAN
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State | NJ
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Zip | 08736-1815
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Country | US
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Telephone | 609-923-7555
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 26NJ00992800
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License Number State | NJ
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