Provider Demographics
NPI:1639492416
Name:BUDER, BRIAN FREDERICHE
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:FREDERICHE
Last Name:BUDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 STATE ROUTE 165
Mailing Address - Street 2:
Mailing Address - City:SHARON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13459-3307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 BROADWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2719
Practice Address - Country:US
Practice Address - Phone:518-694-9907
Practice Address - Fax:518-694-9914
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227417-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse