Provider Demographics
NPI:1811923618
Name:BUCO, JOSE HAYAG (PT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:HAYAG
Last Name:BUCO
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:110 OCEAN PKWY A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2492
Mailing Address - Country:US
Mailing Address - Phone:718-854-9055
Mailing Address - Fax:718-854-9121
Practice Address - Street 1:110 OCEAN PKWY
Practice Address - Street 2:PROFESSIONAL SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2457
Practice Address - Country:US
Practice Address - Phone:718-854-9055
Practice Address - Fax:718-854-9121
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013152-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ171671Medicare ID - Type UnspecifiedMEDICARE PART B