Provider Demographics
NPI:1154076289
Name:BRUCK, FAIGE (CODA)
Entity Type:Individual
Prefix:
First Name:FAIGE
Middle Name:
Last Name:BRUCK
Suffix:
Gender:F
Credentials:CODA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W GATE RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3126
Mailing Address - Country:US
Mailing Address - Phone:845-659-0390
Mailing Address - Fax:
Practice Address - Street 1:21 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-2061
Practice Address - Country:US
Practice Address - Phone:845-244-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant