Provider Demographics
NPI:1700997004
Name:BUCCI, MARY (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BUCCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-740-0607
Mailing Address - Fax:973-422-0353
Practice Address - Street 1:446 BELLEVUE AVENUE
Practice Address - Street 2:MERCER MEDICAL CENTER
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-394-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN03961700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P62584Medicare UPIN
NJ089663Medicare ID - Type Unspecified