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General NPI Number Information
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NPI Number | 1255428322
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Entity Type | Individual
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Provider Name | BRUCE PHARISS MD
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Gender | Male
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 8 HILLSIDE AVE SUITE 106
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2129
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Country | US
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Telephone | 973-509-2371
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Fax | 973-744-9003
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Provider Business Mailing Address
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Address Line | 8 HILLSIDE AVE SUITE 106
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2129
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Country | US
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Telephone | 973-509-2371
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Fax | 973-744-9003
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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 | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 188784
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA08185900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 188784
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 25MA08185900
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License Number State | NJ
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