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General NPI Number Information
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NPI Number | 1528556412
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Entity Type | Individual
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Provider Name | SAMUEL BRUCE MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 525 E 68TH ST
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City | NEW YORK
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State | NY
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Zip | 10065-4870
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Country | US
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Telephone | 212-746-4749
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 YORK AVE APT 26M
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City | NEW YORK
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State | NY
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Zip | 10021-4868
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Country | US
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Telephone | 201-788-7948
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 316735
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License Number State | NY
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