Provider Demographics
NPI:1336655851
Name:BUCYK, JEFFRY THOMAS
Entity Type:Individual
Prefix:MR
First Name:JEFFRY
Middle Name:THOMAS
Last Name:BUCYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 AMESBURY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NH
Mailing Address - Zip Code:03858-3205
Mailing Address - Country:US
Mailing Address - Phone:603-819-3423
Mailing Address - Fax:
Practice Address - Street 1:225 CANAL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4554
Practice Address - Country:US
Practice Address - Phone:978-542-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer