MEDICARE: KERI BRUCATO M.ED.

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	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1376776310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERI BRUCATO M.ED.

Provider Business Mailing Address
First Line	:	210 SHORE RD
Second Line	:	5E
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4235
Country	:	US
Telephone Number	:	516-238-8699
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 SHORE RD
Second Line	:	5E
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4235
Country	:	US
Telephone Number	:	516-238-8699
Fax Number	:

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

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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