Provider Demographics
NPI:1205934718
Name:BUERKLE, AUGUST R JR (MD)
Entity type:Individual
Prefix:
First Name:AUGUST
Middle Name:R
Last Name:BUERKLE
Suffix:JR
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 1:5100 W TAFT RD
Mailing Address - Street 2:STE 2R
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-457-4400
Mailing Address - Fax:315-457-3400
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:STE 2R
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-457-4400
Practice Address - Fax:315-457-3400
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-09-29
Deactivation Date:2022-09-28
Deactivation Code:
Reactivation Date:2022-09-29
Provider Licenses
StateLicense IDTaxonomies
NY107052207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00558663Medicaid
NY0558663Medicaid
NY0558663Medicaid
NY31071CMedicare ID - Type Unspecified
NY0452130001Medicare NSC
NY00558663Medicaid