Provider Demographics
NPI:1851447205
Name:BRUNO, BRYAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JOHN
Last Name:BRUNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:280 MADISON AVE RM 1102
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0817
Mailing Address - Country:US
Mailing Address - Phone:212-717-4869
Mailing Address - Fax:917-409-5405
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-717-4869
Practice Address - Fax:917-409-5405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2036152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY71M441Medicare PIN