Provider Demographics
NPI:1891889382
Name:BUCK, GARY A (CRNFA)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:BUCK
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-0331
Mailing Address - Country:US
Mailing Address - Phone:973-957-0551
Mailing Address - Fax:866-396-3054
Practice Address - Street 1:62 TUCKAHOE RD
Practice Address - Street 2:
Practice Address - City:DOROTHY
Practice Address - State:NJ
Practice Address - Zip Code:08317-9702
Practice Address - Country:US
Practice Address - Phone:973-957-0551
Practice Address - Fax:866-396-3054
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09467800163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
22-3816899OtherTIN