Provider Demographics
NPI:1174022347
Name:HOCHSTADT, BRUCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:HOCHSTADT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAKEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5010
Mailing Address - Country:US
Mailing Address - Phone:847-433-8442
Mailing Address - Fax:
Practice Address - Street 1:2 TOWER CENTER BLVD STE 1101G
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1100
Practice Address - Country:US
Practice Address - Phone:646-668-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT30185208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery