Provider Demographics
NPI:1174645097
Name:NUMEROFF, BRUCE AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:AARON
Last Name:NUMEROFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 ROUTE 45
Mailing Address - Street 2:SUITE 109
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3521
Mailing Address - Country:US
Mailing Address - Phone:845-354-1064
Mailing Address - Fax:845-354-2809
Practice Address - Street 1:978 ROUTE 45
Practice Address - Street 2:SUITE 109
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3521
Practice Address - Country:US
Practice Address - Phone:845-354-1064
Practice Address - Fax:845-354-2809
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7E021Medicare ID - Type UnspecifiedPROVIDER NUMBER