Provider Demographics
NPI:1508998485
Name:BRUST, JAMES CM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CM
Last Name:BRUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-944-3840
Mailing Address - Fax:718-944-3841
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-944-3840
Practice Address - Fax:718-944-3841
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine