Provider Demographics
NPI:1497829469
Name:BUONINCONTRO, GUY ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:ANDREW
Last Name:BUONINCONTRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GUY
Other - Middle Name:A
Other - Last Name:BUONINCONTRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO,
Mailing Address - Street 1:11 PENDLETON DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1919
Mailing Address - Country:US
Mailing Address - Phone:856-424-1489
Mailing Address - Fax:
Practice Address - Street 1:104 ROUTE 72 EAST
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:NJ
Practice Address - Zip Code:08064-0130
Practice Address - Country:US
Practice Address - Phone:609-726-1000
Practice Address - Fax:609-726-1387
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB24073207Q00000X
NJ25MB02407300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ551596B1GOtherMEDICARE BILLING NO.
NJE76767Medicare UPIN
NJ551596Medicare ID - Type Unspecified