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General NPI Number Information
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NPI Number | 1023497740
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Entity Type | Individual
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Provider Name | LARRY MICHAEL BRUNI MD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 1 PINNACLE PL SUITE 102
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City | ALBANY
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State | NY
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Zip | 12203-3496
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Country | US
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Telephone | 518-360-1011
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Fax | 518-278-4417
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Provider Business Mailing Address
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Address Line | 370 PARTRIDGE ST
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City | ALBANY
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State | NY
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Zip | 12208-2939
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Country | US
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Telephone | 518-812-4899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 275946
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101-037258
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License Number State | VA
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