Provider Demographics
NPI:1558971358
Name:BUCKLEY, KIRSTEN LANE (APN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LANE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1815
Mailing Address - Country:US
Mailing Address - Phone:609-923-7555
Mailing Address - Fax:
Practice Address - Street 1:9 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1539
Practice Address - Country:US
Practice Address - Phone:732-744-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00992800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics