Basic Information
| Provider Information | |||||||||
| NPI: | 1649407495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUCIA | ||||||||
| FirstName: | EDWARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1728 SUNRISE HWY | ||||||||
| Address2: | |||||||||
| City: | MERRICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115663745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169924700 | ||||||||
| FaxNumber: | 5169924722 | ||||||||
| Practice Location | |||||||||
| Address1: | 660 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117582391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167980111 | ||||||||
| FaxNumber: | 5167980152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2009 | ||||||||
| LastUpdateDate: | 08/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.