Provider Demographics
NPI:1881902799
Name:BUONO, AMY C (MD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:BUONO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MCRAE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6507
Mailing Address - Country:US
Mailing Address - Phone:973-868-1056
Mailing Address - Fax:
Practice Address - Street 1:171 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1825
Practice Address - Country:US
Practice Address - Phone:973-912-0400
Practice Address - Fax:973-912-8340
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA09255000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5222206-GROUPMedicaid
NJ0412660Medicaid