Healthcare Provider Details

I. General information

NPI: 1063661973
Provider Name (Legal Business Name): LAURIE JANE BRUCIA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 04/23/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLUMBIA UNIVERSITY, ALLEN HOSPITAL DIVISION 5141 BROADWAY
NEW YORK NY
10034
US

IV. Provider business mailing address

5 KENNETH AVE
NORTH BELLMORE NY
11710-3038
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-4200
  • Fax:
Mailing address:
  • Phone: 347-569-3758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP1943082
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00085801
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001504-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: