Provider Demographics
NPI:1902970072
Name:BUIS, ROBERT T (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:BUIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2344
Mailing Address - Country:US
Mailing Address - Phone:973-423-2116
Mailing Address - Fax:973-423-4114
Practice Address - Street 1:674 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2344
Practice Address - Country:US
Practice Address - Phone:973-423-2116
Practice Address - Fax:973-423-4114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00336100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4241164OtherAETNA TRADITIONAL
NJ25958OtherAETNA HMO
NJP2753913OtherOXFORD
NJP2753913OtherOXFORD
NJ520309Medicare PIN