Basic Information
| Provider Information | |||||||||
| NPI: | 1770946964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUNO | ||||||||
| FirstName: | CHANTAL | ||||||||
| MiddleName: | DOMINIQUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | NYU LANGONE HOSPITAL LONG ISLAND | ||||||||
| Address2: | 259 1ST STREET | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166630333 | ||||||||
| FaxNumber: | 5163028648 | ||||||||
| Practice Location | |||||||||
| Address1: | NYU LANGONE HOSPITAL LONG ISLAND | ||||||||
| Address2: | 259 1ST STREET | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166630333 | ||||||||
| FaxNumber: | 5166632310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2016 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 303171 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 25MB09836400 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | DO034641 | DC | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | 303171 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
No ID Information.