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General NPI Number Information
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NPI Number | 1689497554
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Entity Type | Individual
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Provider Name | BRUCE PROFSKY PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 4102 13TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11219-1389
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Country | US
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Telephone | 718-400-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 3606 AVENUE S
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City | BROOKLYN
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State | NY
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Zip | 11234-4830
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Country | US
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Telephone | 718-419-8044
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405636
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License Number State | NY
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