MEDICARE: DR. IBRAHIM SALEM BUKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	25MA03741400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295707636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IBRAHIM SALEM BUKER M.D.

Provider Business Mailing Address
First Line	:	4 GREEN LEAF WAY
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1048
Country	:	US
Telephone Number	:	732-264-7208
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BETHANY RD BLDG 6
Second Line	:	SUITE 85
City	:	HAZLET
State	:	NJ
Zip	:	07730-1669
Country	:	US
Telephone Number	:	732-264-7208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	03/24/2010

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