Provider Demographics
NPI:1316200041
Name:BUCHSBAUM, BRENDA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:BUCHSBAUM
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1338
Mailing Address - Country:US
Mailing Address - Phone:908-361-6688
Mailing Address - Fax:908-558-9463
Practice Address - Street 1:6 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1338
Practice Address - Country:US
Practice Address - Phone:908-361-6688
Practice Address - Fax:908-558-9463
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1778025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist