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General NPI Number Information
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NPI Number | 1861627077
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Entity Type | Organization
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Legal Business Name | THREE VILLAGE NEUROPHYSIOLOGY, PLLC
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 5 ALILAH CT
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City | MILLER PLACE
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State | NY
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Zip | 11764-1902
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Country | US
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Telephone | 631-521-4137
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Fax |
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Provider Business Mailing Address
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Address Line | 5 ALILAH CT
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City | MILLER PLACE
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State | NY
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Zip | 11764-1902
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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 | PRESIDENT
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Name | DR. JAMES BRUNO
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Credential | M.D.
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Telephone | 631-521-4137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 234763
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License Number State | NY
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