Provider Demographics
NPI:1942215694
Name:TAPPER, BRUCE Y
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:Y
Last Name:TAPPER
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 1:200 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3802
Mailing Address - Country:US
Mailing Address - Phone:973-473-1970
Mailing Address - Fax:973-594-1708
Practice Address - Street 1:200 GREGORY AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3802
Practice Address - Country:US
Practice Address - Phone:973-473-1970
Practice Address - Fax:973-594-1708
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA015751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0386405Medicaid
NJ0386405Medicaid