Provider Demographics
NPI:1073616520
Name:BUXBAUM, FREDERICK DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:DAVID
Last Name:BUXBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 WEST 6 ST
Mailing Address - Street 2:APT 1-A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4949
Mailing Address - Country:US
Mailing Address - Phone:718-331-1100
Mailing Address - Fax:718-331-1101
Practice Address - Street 1:1501 WEST 6 ST
Practice Address - Street 2:APT 1-A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4949
Practice Address - Country:US
Practice Address - Phone:718-331-1100
Practice Address - Fax:718-331-1101
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002489213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00413718Medicaid
NY00413718Medicaid
T50782Medicare UPIN