Provider Demographics
NPI:1760495048
Name:BRUCKNER, HOWARD WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:WARREN
Last Name:BRUCKNER
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 1:2330 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5930
Mailing Address - Country:US
Mailing Address - Phone:718-732-4050
Mailing Address - Fax:718-881-4445
Practice Address - Street 1:2330 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5930
Practice Address - Country:US
Practice Address - Phone:718-732-4050
Practice Address - Fax:718-881-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1013AR1OtherBLUE CROSS BLUE SHIELD
NY00187302Medicaid
NY167805OtherELDERPLAN
NYP1730535OtherOXFORD
NY083520OtherGHI HMO
NY2171382OtherUS HEALTHCARE
NY2590950OtherGHI PPO
NY1013AR1OtherBLUE CROSS BLUE SHIELD
NYB16825Medicare UPIN