Provider Demographics
NPI:1043670284
Name:BRUEN, ELIZABETH (ASCLS/AAAHP/RPT/NPT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:BRUEN
Suffix:
Gender:F
Credentials:ASCLS/AAAHP/RPT/NPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ELTING CT 3RD FL GOV'T BLDG.
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-1330
Mailing Address - Country:US
Mailing Address - Phone:845-853-0676
Mailing Address - Fax:845-232-2207
Practice Address - Street 1:2 ELTING CT FL 3
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1330
Practice Address - Country:US
Practice Address - Phone:845-853-0676
Practice Address - Fax:845-232-2207
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X, 225500000X, 251E00000X, 3747A0650X, 374U00000X, 390200000X
NY251J00000X
NY132413291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No170300000XOther Service ProvidersGenetic Counselor, MS
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program