Provider Demographics
NPI:1417508979
Name:BUCKLES, VERONICA
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:BUCKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WEST MERRICK ROAD BX 7451
Mailing Address - Street 2:7451 P.O. BOX
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-7451
Mailing Address - Country:US
Mailing Address - Phone:516-580-6739
Mailing Address - Fax:516-538-3019
Practice Address - Street 1:53 ROUTE 17K
Practice Address - Street 2:
Practice Address - City:NEWHURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:516-580-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251K00000X, 251T00000X, 251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251J00000XAgenciesNursing Care