Provider Demographics
NPI:1073532842
Name:COLE, BRUNO NATHANIEL LATUNDE' (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:NATHANIEL LATUNDE'
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:707 ALEXANDER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6331
Mailing Address - Country:US
Mailing Address - Phone:609-919-0303
Mailing Address - Fax:609-919-0008
Practice Address - Street 1:707 ALEXANDER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6331
Practice Address - Country:US
Practice Address - Phone:609-919-0303
Practice Address - Fax:609-919-0008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04022200208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6398804Medicaid
NJE53213Medicare UPIN
NJ6398804Medicaid