MEDICARE: ANGEL BRUCE

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	235500000X	Speech/Language/Hearing Specialist/Technologist	2733892	NY

General Provider Information

NPI Number	:	1609634971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL BRUCE

Provider Business Mailing Address
First Line	:	1193 E 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2411
Country	:	US
Telephone Number	:	917-834-6486
Fax Number	:

Provider Business Practice Location Address
First Line	:	1193 E 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2411
Country	:	US
Telephone Number	:	917-834-6486
Fax Number	:

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

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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Directions to “ ANGEL BRUCE ” Practice Location

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