MEDICARE: GREGORY BRUCATO, MD LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208200000X	Plastic Surgery Physician
2	208600000X	Surgery Physician
3	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1730313503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY BRUCATO, MD LLC

Provider Business Mailing Address
First Line	:	38B GROVE ST
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4665
Country	:	US
Telephone Number	:	203-431-7644
Fax Number	:	203-431-7934

Provider Business Practice Location Address
First Line	:	38B GROVE ST
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4665
Country	:	US
Telephone Number	:	203-431-7644
Fax Number	:	203-431-7934

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY BRUCATO
Credential	:	MD
Telephone Number	:	203-431-7644

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	05/28/2009

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