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General NPI Number Information
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NPI Number | 1164509444
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Entity Type | Individual
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Provider Name | BASIL BRUNO M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 18 RAILROAD AVE SUITE 103
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-4105
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Country | US
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Telephone | 201-928-0748
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Fax | 201-928-0842
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Provider Business Mailing Address
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Address Line | 18 RAILROAD AVE SUITE 103
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-4105
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Country | US
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Telephone | 201-928-0748
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Fax | 201-928-0842
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MA055053
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 270553
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA05505300
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License Number State | NJ
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