Provider Demographics
NPI:1265563787
Name:MELLER, BRUCE L (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
Last Name:MELLER
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 1:400 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2223
Mailing Address - Country:US
Mailing Address - Phone:845-897-8076
Mailing Address - Fax:
Practice Address - Street 1:400 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2223
Practice Address - Country:US
Practice Address - Phone:845-897-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00915866Medicaid
NYA63200Medicare UPIN
NY54D301Medicare ID - Type Unspecified