MEDICARE: JOSEPH JOHN BRUNO LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	273864	NY

General Provider Information

NPI Number	:	1144503590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH JOHN BRUNO LPN

Provider Business Mailing Address
First Line	:	150 BROADWAY STE 310
Second Line	:
City	:	MENANDS
State	:	NY
Zip	:	12204-2726
Country	:	US
Telephone Number	:	518-694-9907
Fax Number	:	518-694-9914

Provider Business Practice Location Address
First Line	:	150 BROADWAY STE 310
Second Line	:
City	:	MENANDS
State	:	NY
Zip	:	12204-2726
Country	:	US
Telephone Number	:	518-694-9907
Fax Number	:	518-694-9914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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Directions to “ JOSEPH JOHN BRUNO LPN” Practice Location

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