Provider Demographics
NPI:1063764637
Name:BUYCK, MEGAN (MS TOD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BUYCK
Suffix:
Gender:F
Credentials:MS TOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 VAN RENSSELAER BLVD.
Mailing Address - Street 2:DUTCH VILLAGE APARTMENTS APARTMENT 6CR
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-4713
Mailing Address - Country:US
Mailing Address - Phone:607-725-6645
Mailing Address - Fax:
Practice Address - Street 1:597 3RD AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-2509
Practice Address - Country:US
Practice Address - Phone:518-233-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628332121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist