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General NPI Number Information
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NPI Number | 1932191665
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Entity Type | Individual
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Provider Name | BURTON TUCKER MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 11 OVERLOOK RD SUITE 100
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City | SUMMIT
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State | NJ
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Zip | 07901-3577
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Country | US
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Telephone | 973-377-2400
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Fax | 973-377-4117
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Provider Business Mailing Address
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Address Line | 77 BRANT AVE SUITE 200
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City | CLARK
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State | NJ
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Zip | 07066-1560
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Country | US
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Telephone | 732-382-0091
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Fax | 732-382-8570
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MA21625
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License Number State | NJ
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