Healthcare Provider Details

I. General information

NPI: 1396955720
Provider Name (Legal Business Name): BRUCE JAY MILNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 STATE ROUTE 375
WEST HURLEY NY
12491-5633
US

IV. Provider business mailing address

269 STATE ROUTE 375
WEST HURLEY NY
12491-5633
US

V. Phone/Fax

Practice location:
  • Phone: 845-679-4000
  • Fax: 456-790-4015
Mailing address:
  • Phone: 845-679-4000
  • Fax: 456-790-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number028311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: