Provider Demographics
NPI:1851465793
Name:LASHLEY, BRUCE WAYNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WAYNE
Last Name:LASHLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E 12TH ST APT MD4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4667
Mailing Address - Country:US
Mailing Address - Phone:212-949-2901
Mailing Address - Fax:212-949-1914
Practice Address - Street 1:44 E 12TH ST APT MD4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4667
Practice Address - Country:US
Practice Address - Phone:212-949-2901
Practice Address - Fax:212-949-1914
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003313213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0056972OtherGHI
NY133435602OtherUNITED HEALTH CARE
NY51859POtherHIP
NY71634OtherAETNA
NY48814900001OtherDME DEMARC
NY133435602Other1199 FUND
NYBLOP347810OtherEMPIRE BC
NYNS013OtherOXFORD #
NYN003313C20OtherHEALTHFIRST
NY0056972OtherGHI
NYBLOP347810OtherEMPIRE BC
NYNS013OtherOXFORD #
NYP34781Medicare ID - Type Unspecified