Provider Demographics
NPI:1801956271
Name:KANENGISER, BRUCE E (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:KANENGISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:371 HOES LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4143
Mailing Address - Country:US
Mailing Address - Phone:732-981-1444
Mailing Address - Fax:732-562-1586
Practice Address - Street 1:371 HOES LN
Practice Address - Street 2:SUITE 100
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4143
Practice Address - Country:US
Practice Address - Phone:732-981-1444
Practice Address - Fax:732-562-1586
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA041412207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83A761Medicare ID - Type Unspecified
NJ121074Medicare UPIN