Provider Demographics
NPI:1164693784
Name:BRUCE LUM NATHANIEL SASSON LLP
Entity Type:Organization
Organization Name:BRUCE LUM NATHANIEL SASSON LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-965-9823
Mailing Address - Street 1:370 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-8131
Mailing Address - Country:US
Mailing Address - Phone:718-965-9823
Mailing Address - Fax:718-499-5700
Practice Address - Street 1:370 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-8131
Practice Address - Country:US
Practice Address - Phone:718-965-9823
Practice Address - Fax:718-499-5700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRUCE LUM NATHANIEL SASSON LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-23
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0377411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02365199Medicaid