Healthcare Provider Details

I. General information

NPI: 1336120211
Provider Name (Legal Business Name): BRUCE IRA KAPPEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CROSSWAYS PARK DR STE 103
WOODBURY NY
11797-2036
US

IV. Provider business mailing address

40 CROSSWAYS PARK DR STE 103
WOODBURY NY
11797-2036
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-5533
  • Fax: 516-364-4080
Mailing address:
  • Phone: 516-921-5533
  • Fax: 516-364-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number162293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: