MEDICARE: MARIEL BUQUE PH.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	103T00000X	Psychologist	024129	NY

General Provider Information

NPI Number	:	1679952733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIEL BUQUE PH.D.

Provider Business Mailing Address
First Line	:	21 LEXINGTON AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-5715
Country	:	US
Telephone Number	:	201-255-7985
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 LEXINGTON AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-5715
Country	:	US
Telephone Number	:	201-255-7985
Fax Number	:

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

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	06/02/2024

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