MEDICARE: DR. LANCE RICHARD BRUCK

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	207V00000X	Obstetrics & Gynecology Physician	200006	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396890075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANCE RICHARD BRUCK

Provider Business Mailing Address
First Line	:	42 ROCK SHELTER RD
Second Line	:
City	:	WACCABUC
State	:	NY
Zip	:	10597-1034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 TENBROECK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2007
Country	:	US
Telephone Number	:	718-430-8701
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/09/2024

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Directions to “ DR. LANCE RICHARD BRUCK ” Practice Location

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