MEDICARE: DR. JOSEPH J. BRUSCA D.C.

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	111N00000X	Chiropractor	X04423-1	NY

General Provider Information

NPI Number	:	1932244142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH J. BRUSCA D.C.

Provider Business Mailing Address
First Line	:	81 FOREST GRN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1711
Country	:	US
Telephone Number	:	718-874-1024
Fax Number	:

Provider Business Practice Location Address
First Line	:	5493 MERRICK RD
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-6215
Country	:	US
Telephone Number	:	516-641-4067
Fax Number	:	516-541-6492

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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