MEDICARE: MR. GERALD LEE BRUCE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	489321-1	NY

General Provider Information

NPI Number	:	1083042188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD LEE BRUCE RN

Provider Business Mailing Address
First Line	:	57 SPRING ST
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-6320
Country	:	US
Telephone Number	:	845-380-7196
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 MILL ST
Second Line	:	ASTOR SERVICES FOR CHILDREN AND THEIR FAMILIES
City	:	RHINEBECK
State	:	NY
Zip	:	12571-5005
Country	:	US
Telephone Number	:	845-871-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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