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General NPI Number Information
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NPI Number | 1649407495
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Entity Type | Individual
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Provider Name | EDWARD BRUCIA
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Gender | Male
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 660 BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2391
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Country | US
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Telephone | 516-798-0111
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Fax | 516-798-0152
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Provider Business Mailing Address
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Address Line | 1728 SUNRISE HWY
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City | MERRICK
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State | NY
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Zip | 11566-3745
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Country | US
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Telephone | 516-992-4700
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Fax | 516-992-4722
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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