Provider Demographics
NPI:1184137796
Name:BRUCK, WILLIAM W (NP,FNP-BC,PMHNP-BC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:BRUCK
Suffix:
Gender:
Credentials:NP,FNP-BC,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 SUGARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-4924
Mailing Address - Country:US
Mailing Address - Phone:856-405-5140
Mailing Address - Fax:
Practice Address - Street 1:1200 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1331
Practice Address - Country:US
Practice Address - Phone:856-792-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00757800363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily