Basic Information
| Provider Information | |||||||||
| NPI: | 1407865280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCHBERGER | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | MPT DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91 COLUMBUS ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130213121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155153117 | ||||||||
| FaxNumber: | 3155153121 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 WEST LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155153117 | ||||||||
| FaxNumber: | 3155153121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 028390 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 111NX0800X | X008418-1 | NY | N | Chiropractic Providers | Chiropractor | Orthopedic |
No ID Information.