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NPI Code Detail

MEDICARE: LAURIE ANNE BUCKENBERGER NP

MEDICARE: LAURIE ANNE BUCKENBERGER NP
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
1363LA2200XAdult Health Nurse Practitioner300980NY

General Provider Information

NPI Number : 1568782514
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE ANNE BUCKENBERGER NP
Provider Business Mailing Address
First Line : 555 W 57TH ST
Second Line : 19TH FLOOR
City : NEW YORK
State : NY
Zip : 10019-2925
Country : US
Telephone Number : 212-523-5543
Fax Number :
Provider Business Practice Location Address
First Line : 555 W 57TH ST
Second Line : 19TH FLOOR
City : NEW YORK
State : NY
Zip : 10019-2925
Country : US
Telephone Number : 212-523-5543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2010
Last Update Date : 06/01/2010

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