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NPI Code Detail

MEDICARE: DR. HAROLD M BRUCK M.D.

MEDICARE: DR. HAROLD M BRUCK M.D.
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
12086X0206XSurgical Oncology PhysicianMA01983400NJ
22086X0206XSurgical Oncology Physician090825NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1090825OTHERNYSTATE MEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MA01983400OTHERNJSTATE MEDICAL LICENSE

General Provider Information

NPI Number : 1740246099
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HAROLD M BRUCK M.D.
Provider Business Mailing Address
First Line : 385 S MAPLE AVE
Second Line :
City : GLEN ROCK
State : NJ
Zip : 07452-1543
Country : US
Telephone Number : 201-652-2800
Fax Number : 201-652-2963
Provider Business Practice Location Address
First Line : 385 S MAPLE AVE
Second Line :
City : GLEN ROCK
State : NJ
Zip : 07452-1543
Country : US
Telephone Number : 201-652-2800
Fax Number : 201-652-2963
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/12/2010

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