Provider Demographics
NPI:1083436208
Name:BUMBACO, DAVEY ANTHONY
Entity type:Individual
Prefix:
First Name:DAVEY
Middle Name:ANTHONY
Last Name:BUMBACO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 WAHNETAH DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805
Mailing Address - Country:US
Mailing Address - Phone:732-853-6969
Mailing Address - Fax:
Practice Address - Street 1:537 WAHNETAH DRIVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805
Practice Address - Country:US
Practice Address - Phone:732-853-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-24-369878106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician