Provider Demographics
NPI:1073542510
Name:XU, BRUCE (LAC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HIDDEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2897
Mailing Address - Country:US
Mailing Address - Phone:585-385-4510
Mailing Address - Fax:585-385-4519
Practice Address - Street 1:90 OFFICE PARK WAY
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1711
Practice Address - Country:US
Practice Address - Phone:585-385-4510
Practice Address - Fax:585-385-4519
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010001054OtherBLUE CHOICE
NY7903108OtherAETNA
NY130063GBOtherPREFFERED CARE
NYP020001054OtherBLUECROSS&BLUESHIELD