Provider Demographics
NPI:1295707636
Name:BUKER, IBRAHIM SALEM (MD)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:SALEM
Last Name:BUKER
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 1:4 GREEN LEAF WAY
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1048
Mailing Address - Country:US
Mailing Address - Phone:732-264-7208
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD BLDG 6
Practice Address - Street 2:SUITE 85
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1669
Practice Address - Country:US
Practice Address - Phone:732-264-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03741400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1441906Medicaid
451913Medicare ID - Type Unspecified
NJC55259Medicare UPIN