Provider Demographics
NPI:1508081621
Name:BUCKNER, JANET MARIAN (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARIAN
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 SMITH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3578
Mailing Address - Country:US
Mailing Address - Phone:516-833-6382
Mailing Address - Fax:917-268-9752
Practice Address - Street 1:1991 SMITH ST
Practice Address - Street 2:STE 200
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3578
Practice Address - Country:US
Practice Address - Phone:516-833-6382
Practice Address - Fax:917-268-9752
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1954532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
494BD1Medicare ID - Type Unspecified
NYF93065Medicare UPIN