Healthcare Provider Details

I. General information

NPI: 1760495048
Provider Name (Legal Business Name): HOWARD WARREN BRUCKNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ASTOR AVE FL 2B
BRONX NY
10469
US

IV. Provider business mailing address

1500 ASTOR AVE FL 2B
BRONX NY
10469
US

V. Phone/Fax

Practice location:
  • Phone: 718-941-6000
  • Fax: 718-941-6071
Mailing address:
  • Phone: 718-941-6000
  • Fax: 718-941-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number106681
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number106681
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number106681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: