Provider Demographics
NPI:1336120211
Name:KAPPEL, BRUCE IRA (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:IRA
Last Name:KAPPEL
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 1:40 CROSSWAYS PARK DR
Mailing Address - Street 2:STE 103
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2036
Mailing Address - Country:US
Mailing Address - Phone:516-921-5533
Mailing Address - Fax:516-364-4080
Practice Address - Street 1:40 CROSSWAYS PARK DR
Practice Address - Street 2:STE 103
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2036
Practice Address - Country:US
Practice Address - Phone:516-921-5533
Practice Address - Fax:516-364-4080
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162293207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01254888Medicaid
NY01254888Medicaid
12F831Medicare PIN