Provider Demographics
NPI:1316005614
Name:BUCKLEY, RICHARD JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:BUCKLEY
Suffix:JR
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 1:4231 MAPLE RD
Mailing Address - Street 2:AMHERST SURGICAL ASSOCIATES
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1097
Mailing Address - Country:US
Mailing Address - Phone:716-837-9111
Mailing Address - Fax:716-833-5135
Practice Address - Street 1:4231 MAPLE RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1097
Practice Address - Country:US
Practice Address - Phone:716-837-9111
Practice Address - Fax:716-833-5135
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125872208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000507543001OtherBLUE SHIELD BLUE CROSS
1701469OtherINDEPENDENT HEALTH
NY00670640060Medicaid
00010022101OtherUNIVERA
NY00670640060Medicaid
B36077Medicare UPIN