Basic Information
| Provider Information | |||||||||
| NPI: | 1174575369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCH | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 COURTYARD DRIVE | ||||||||
| Address2: | BLDG 600 | ||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087220030 | ||||||||
| FaxNumber: | 9087220188 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 COURTYARD DRIVE | ||||||||
| Address2: | BLDG 600 | ||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087220030 | ||||||||
| FaxNumber: | 9087220188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 12/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | MAO48051 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0322504 | 05 | NJ | MEDICAID |