Provider Demographics
NPI:1114905437
Name:DECTER, BRUCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:DECTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-327-0001
Mailing Address - Fax:516-326-9753
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:SUITE 411
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-327-0001
Practice Address - Fax:516-326-9753
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY179558207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01482186Medicaid
53H681Medicare ID - Type Unspecified
NY01482186Medicaid