Provider Demographics
NPI:1255415204
Name:MALEN, BRUCE RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:RICHARD
Last Name:MALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:33 RONALD REAGAN BLVD
Mailing Address - Street 2:PO BOX 833
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-0833
Mailing Address - Country:US
Mailing Address - Phone:845-986-6601
Mailing Address - Fax:845-986-6613
Practice Address - Street 1:33 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-0833
Practice Address - Country:US
Practice Address - Phone:845-986-6601
Practice Address - Fax:845-986-6613
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20386207W00000X
NJ25MA03318400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00305202Medicaid
NY00305202Medicaid
NY313781Medicare ID - Type Unspecified
NJ017195Medicare ID - Type Unspecified