Provider Demographics
NPI:1396820627
Name:CHRISTOPHER J. BRUCE, M.D., PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER J. BRUCE, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-997-1599
Mailing Address - Street 1:15 N BROADWAY
Mailing Address - Street 2:SUITE J
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2214
Mailing Address - Country:US
Mailing Address - Phone:914-997-1599
Mailing Address - Fax:914-997-1563
Practice Address - Street 1:15 N BROADWAY
Practice Address - Street 2:SUITE J
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2214
Practice Address - Country:US
Practice Address - Phone:914-997-1599
Practice Address - Fax:914-997-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2004006-1208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY910632Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NYF03927Medicare UPIN