Provider Demographics
NPI:1477587640
Name:JOHN J. BUCHBACH
Entity Type:Organization
Organization Name:JOHN J. BUCHBACH
Other - Org Name:EAST COAST REHAB, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:BUCHBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-370-5790
Mailing Address - Street 1:4944C EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4809
Mailing Address - Country:US
Mailing Address - Phone:703-370-5790
Mailing Address - Fax:703-370-5793
Practice Address - Street 1:4944C EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4809
Practice Address - Country:US
Practice Address - Phone:703-370-5790
Practice Address - Fax:703-370-5793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0622638332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009120335Medicaid
VA009120335Medicaid