Healthcare Provider Details

I. General information

NPI: 1316003221
Provider Name (Legal Business Name): BRUNO F CASANOVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 ATLANTIC AVE
BROOKLYN NY
11217-1702
US

IV. Provider business mailing address

55 WATER ST 2ND FLOOR
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-6000
  • Fax:
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number254358
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: