MEDICARE: MR. GARY A BUCK CRNFA

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	163WR0006X	Registered Nurse First Assistant	26NO09467800	NJ

General Provider Information

NPI Number	:	1891889382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY A BUCK CRNFA

Provider Business Mailing Address
First Line	:	PO BOX 331
Second Line	:
City	:	MAYS LANDING
State	:	NJ
Zip	:	08330-0331
Country	:	US
Telephone Number	:	973-957-0551
Fax Number	:	866-396-3054

Provider Business Practice Location Address
First Line	:	62 TUCKAHOE RD
Second Line	:
City	:	DOROTHY
State	:	NJ
Zip	:	08317-9702
Country	:	US
Telephone Number	:	973-957-0551
Fax Number	:	866-396-3054

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/26/2020

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