Provider Demographics
NPI:1013008556
Name:BUONOCORE, RICHARD V (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:V
Last Name:BUONOCORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1200 US HIGHWAY 22
Mailing Address - Street 2:STE 2
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2943
Mailing Address - Country:US
Mailing Address - Phone:732-302-1720
Mailing Address - Fax:732-302-1724
Practice Address - Street 1:1200 US HIGHWAY 22
Practice Address - Street 2:STE 2
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2943
Practice Address - Country:US
Practice Address - Phone:732-302-1720
Practice Address - Fax:732-302-1724
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA1057100207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001829830Medicaid
PA042262Medicare ID - Type Unspecified
PA001829830Medicaid