Basic Information
| Provider Information | |||||||||
| NPI: | 1134121981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUONO | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2 CAPITAL WAY STE 456 | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095377300 | ||||||||
| FaxNumber: | 6095377301 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CAPITAL WAY | ||||||||
| Address2: | SUITE 456 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095377300 | ||||||||
| FaxNumber: | 6095377301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | L7319 | TX | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD070105L | PA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 25MA08685200 | NJ | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 152452001 | 05 | AR | MEDICAID | 200023050A | 05 | OK | MEDICAID | 82627 | 01 | AR | BLUE CROSS ARKANSAS | OTHER | 179117500 | 01 | U S DEPT OF LABOR | OTHER | 0242667 | 05 | NJ | MEDICAID | 169004201 | 05 | TX | MEDICAID | 18383000000 | 01 | AR | QUALCHOICE | OTHER | 82627 | 01 | AR | BLUE CROSS | OTHER | 82627 | 01 | FIRST PYRAMID LIFE | OTHER | MDL7319 | 01 | WORKERS' COMPENSATION | OTHER | 8K5493 | 01 | TX | BLUE CROSS TEXAS | OTHER | 169004201 | 01 | INDIGENT HEALTH CARE | OTHER | 5575000001 | 01 | TX | CIGNA GOVERNMENT SRV | OTHER | 8K5493 | 01 | TX | BLUE CROSS | OTHER | 1871793307 | 01 | TX | CIGNA DME# | OTHER | P00062282 | 01 | TX | RAILROAD MEDICARE | OTHER |