Physician Compare National (NPI:1790718013)

HEALTHCARE PROVIDER: BRUNO MANDUCA M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1790718013
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3375631062
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071113000707
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MANDUCA
	Individual professional last name
Provider First Name	BRUNO
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	184 HOLDEN BLVD
	Group Practice or individual's line 1 address
City	STATEN ISLAND
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	103145159
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7188150710
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330028
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	RICHMOND UNIVERSITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y