Provider Demographics
NPI:1043258486
Name:BUCALO, VICTOR JOHN (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:JOHN
Last Name:BUCALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GRAND AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4967
Mailing Address - Country:US
Mailing Address - Phone:201-567-2277
Mailing Address - Fax:201-567-2639
Practice Address - Street 1:500 GRAND AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4967
Practice Address - Country:US
Practice Address - Phone:201-567-2277
Practice Address - Fax:201-567-2639
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239287-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation