Provider Demographics
NPI:1013919141
Name:BUKOSKY, RICHARD JOSEPH (M D)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:BUKOSKY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036
Mailing Address - Country:US
Mailing Address - Phone:908-925-3318
Mailing Address - Fax:908-925-8646
Practice Address - Street 1:926 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-925-3318
Practice Address - Fax:908-925-8646
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02113000207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2895102Medicaid
US133OtherOXFORD
NJ0150142000OtherAMERIHEALTH
NJ8828709Medicaid
2K0824OtherHEALTHNET
2K0824OtherHEALTHNET
C61648Medicare UPIN
NJ8828709Medicaid