Provider Demographics
NPI:1841244332
Name:TENNER, BRUCE S
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:TENNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81-1 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6406
Mailing Address - Country:US
Mailing Address - Phone:732-341-0560
Mailing Address - Fax:732-341-0574
Practice Address - Street 1:81-1 ROUTE 37 WEST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6428
Practice Address - Country:US
Practice Address - Phone:732-341-0560
Practice Address - Fax:732-341-0574
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05398900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6211402Medicaid
NJ6211402Medicaid
NJ058073Medicare PIN