Healthcare Provider Details

I. General information

NPI: 1073332276
Provider Name (Legal Business Name): ANDREA BRUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FIELD POINT RD
GREENWICH CT
06830-6446
US

IV. Provider business mailing address

120 WAVERLY AVE
MOUNT LAUREL NJ
08054-1143
US

V. Phone/Fax

Practice location:
  • Phone: 201-669-7557
  • Fax:
Mailing address:
  • Phone: 201-669-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number804
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number009096
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: