Provider Demographics
NPI:1780673244
Name:BRUNO, JAMES L (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:BRUNO
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 1:277 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3204
Mailing Address - Country:US
Mailing Address - Phone:718-608-9600
Mailing Address - Fax:718-608-9137
Practice Address - Street 1:277 NELSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3204
Practice Address - Country:US
Practice Address - Phone:718-608-9600
Practice Address - Fax:718-608-9137
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185896207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10672Medicare UPIN
NYW39611Medicare ID - Type Unspecified