Provider Demographics
NPI:1417465683
Name:BUIS, ROBERT G (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:BUIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 LAFAYETTE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2341
Mailing Address - Country:US
Mailing Address - Phone:973-423-2116
Mailing Address - Fax:973-423-4114
Practice Address - Street 1:674 LAFAYETTE AVE
Practice Address - Street 2:STE 5
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2341
Practice Address - Country:US
Practice Address - Phone:973-423-2116
Practice Address - Fax:973-423-4114
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00750500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor