Basic Information
| Provider Information | |||||||||
| NPI: | 1770253098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUFFAMONTE | ||||||||
| FirstName: | MCKEON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 137 ERVIN AVE | ||||||||
| Address2: | |||||||||
| City: | LINWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107578957 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1873 ROUTE 70 E STE 1-J | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080032034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564284030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2021 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC011657 | PA | Y | Chiropractic Providers | Chiropractor |
No ID Information.