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General NPI Number Information
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NPI Number | 1427236835
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Entity Type | Individual
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Provider Name | BRUNO MARIUS SUDITU PA
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Gender | Male
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 6010 BAY PKWY STE 902
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City | BROOKLYN
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State | NY
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Zip | 11204-6091
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Country | US
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Telephone | 718-475-1700
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Fax | 718-475-1702
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Provider Business Mailing Address
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Address Line | 24 STEVENS ST
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City | NORWALK
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State | CT
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Zip | 06850-3852
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Country | US
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Telephone | 203-852-2000
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 014453
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3520
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License Number State | CT
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