Provider Demographics
NPI:1497775753
Name:PATSNER, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:PATSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 SPAULDING PL
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1015
Mailing Address - Country:US
Mailing Address - Phone:732-229-0988
Mailing Address - Fax:732-229-0771
Practice Address - Street 1:19 DAVIS AVE FL 9
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-897-3640
Practice Address - Fax:732-897-3639
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY153152207VX0201X
NJ25MA054843002084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP9645562OtherDEA NUMBER
AP9645562OtherDEA NUMBER