Provider Demographics
NPI:1760603633
Name:PARENT, BRUCE GEORGE (MFA , MA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:GEORGE
Last Name:PARENT
Suffix:
Gender:M
Credentials:MFA , MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 BARROW STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-5734
Mailing Address - Country:US
Mailing Address - Phone:212-989-2357
Mailing Address - Fax:
Practice Address - Street 1:103 ST. MARKS PLACE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009
Practice Address - Country:US
Practice Address - Phone:212-614-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0006731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist