MEDICARE: LUZATO MEDICAL GROUP P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician
3	208800000X	Urology Physician
4	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5501024	OTHER	NY	GHI

General Provider Information

NPI Number	:	1164576385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUZATO MEDICAL GROUP P.C.

Provider Business Mailing Address
First Line	:	1812 COLLEGE POINT BLVD
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2221
Country	:	US
Telephone Number	:	718-461-9105
Fax Number	:	716-461-3392

Provider Business Practice Location Address
First Line	:	1812 COLLEGE POINT BLVD
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2221
Country	:	US
Telephone Number	:	718-461-9105
Fax Number	:	716-461-3392

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACK BRUDER
Credential	:	M.D.
Telephone Number	:	718-461-9105

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	09/11/2025

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Directions to “LUZATO MEDICAL GROUP P.C. ” Practice Location

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