Provider Demographics
NPI:1750511960
Name:BUCKLEY, EILEEN ELIZABETH (NP IN ADULT HEALTH)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:ELIZABETH
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:NP IN ADULT HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FAIRVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2413
Mailing Address - Country:US
Mailing Address - Phone:845-359-2123
Mailing Address - Fax:
Practice Address - Street 1:32 FAIRVIEW LANE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962
Practice Address - Country:US
Practice Address - Phone:845-359-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301458-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
94N071Medicare UPIN