Healthcare Provider Details

I. General information

NPI: 1255428322
Provider Name (Legal Business Name): BRUCE PHARISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HILLSIDE AVE SUITE 106
MONTCLAIR NJ
07042-2129
US

IV. Provider business mailing address

8 HILLSIDE AVE SUITE 106
MONTCLAIR NJ
07042-2129
US

V. Phone/Fax

Practice location:
  • Phone: 973-509-2371
  • Fax: 973-744-9003
Mailing address:
  • Phone: 973-509-2371
  • Fax: 973-744-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number25MA08185900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA08185900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number188784
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number188784
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: