Provider Demographics
NPI:1013904853
Name:BUDDLE, PATRICK M (MD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:M
Last Name:BUDDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HIGHWAY 71
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2805
Mailing Address - Country:US
Mailing Address - Phone:732-974-8100
Mailing Address - Fax:732-974-9125
Practice Address - Street 1:700 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2805
Practice Address - Country:US
Practice Address - Phone:732-974-8100
Practice Address - Fax:732-974-9125
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04418200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3919706Medicaid
NJ521018Medicare ID - Type Unspecified
C59656Medicare UPIN