Provider Demographics
NPI:1154631166
Name:BUCKLEY, MARY J (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 ROUTE 340
Mailing Address - Street 2:DOMINICAN CONVENT
Mailing Address - City:SPARKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10976-1041
Mailing Address - Country:US
Mailing Address - Phone:914-954-6822
Mailing Address - Fax:845-359-3201
Practice Address - Street 1:175 ROUTE 340
Practice Address - Street 2:DOMINICAN CONVENT
Practice Address - City:SPARKILL
Practice Address - State:NY
Practice Address - Zip Code:10976-1041
Practice Address - Country:US
Practice Address - Phone:914-954-6822
Practice Address - Fax:845-359-3201
Is Sole Proprietor?:No
Enumeration Date:2010-10-12
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331865-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily