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General NPI Number Information
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NPI Number | 1164576385
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Entity Type | Organization
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Legal Business Name | LUZATO MEDICAL GROUP P.C.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1812 COLLEGE POINT BLVD
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City | COLLEGE POINT
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State | NY
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Zip | 11356-2221
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Country | US
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Telephone | 718-461-9105
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Fax | 716-461-3392
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Provider Business Mailing Address
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Address Line | 1812 COLLEGE POINT BLVD
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City | COLLEGE POINT
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State | NY
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Zip | 11356-2221
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Country | US
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Telephone | 718-461-9105
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Fax | 716-461-3392
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK BRUDER
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Credential | M.D.
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Telephone | 718-461-9105
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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