Basic Information
Provider Information | |||||||||
NPI: | 1497775753 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PATSNER | ||||||||
FirstName: | BRUCE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 17 SPAULDING PL | ||||||||
Address2: |   | ||||||||
City: | MONMOUTH BEACH | ||||||||
State: | NJ | ||||||||
PostalCode: | 077501015 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7322290988 | ||||||||
FaxNumber: | 7322290771 | ||||||||
Practice Location | |||||||||
Address1: | 19 DAVIS AVE FL 9 | ||||||||
Address2: |   | ||||||||
City: | NEPTUNE | ||||||||
State: | NJ | ||||||||
PostalCode: | 077534488 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7328973640 | ||||||||
FaxNumber: | 7328973639 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2006 | ||||||||
LastUpdateDate: | 08/05/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/05/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 153152 | NY | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 2084P0802X | 25MA05484300 | NJ | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
ID Information
ID | Type | State | Issuer | Description | AP9645562 | 01 |   | DEA NUMBER | OTHER |