Provider Demographics
NPI:1487867859
Name:BUONACORE, BARBARA L (RD, CDE)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:BUONACORE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:L
Other - Last Name:GREENSPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:35 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1267
Mailing Address - Country:US
Mailing Address - Phone:732-888-4155
Mailing Address - Fax:
Practice Address - Street 1:35 BROAD ST
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1267
Practice Address - Country:US
Practice Address - Phone:732-888-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
708475133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education