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General NPI Number Information
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NPI Number | 1396890075
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Entity Type | Individual
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Provider Name | DR. LANCE RICHARD BRUCK
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1601 TENBROECK AVE
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City | BRONX
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State | NY
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Zip | 10461-2007
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Country | US
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Telephone | 718-430-8701
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Fax |
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Provider Business Mailing Address
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Address Line | 42 ROCK SHELTER RD
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City | WACCABUC
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State | NY
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Zip | 10597-1034
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 200006
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License Number State | NY
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