Provider Demographics
NPI:1184477416
Name:FRUSTACE, BRUNO SALVATORE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:SALVATORE
Last Name:FRUSTACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 GRANT ST.
Mailing Address - Street 2:MED ED PODIUM 4. C/O AMANDA KLAGER GME A
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:267 GRANT ST.
Practice Address - Street 2:MED ED PODIUM 4. C/O AMANDA KLAGER GME A
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610
Practice Address - Country:US
Practice Address - Phone:845-591-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program