Healthcare Provider Details

I. General information

NPI: 1215050273
Provider Name (Legal Business Name): BRUNO RECUPERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 AVENUE A
NEW YORK NY
10009-7601
US

IV. Provider business mailing address

26 AVENUE A
NEW YORK NY
10009-7601
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number097574-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: