Provider Demographics
NPI:1083042188
Name:BRUCE, GERALD LEE (RN)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LEE
Last Name:BRUCE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6320
Mailing Address - Country:US
Mailing Address - Phone:845-380-7196
Mailing Address - Fax:
Practice Address - Street 1:6339 MILL ST
Practice Address - Street 2:ASTOR SERVICES FOR CHILDREN AND THEIR FAMILIES
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12571-5005
Practice Address - Country:US
Practice Address - Phone:845-871-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY489321-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse