# BRUCE THEALL DPM LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043518913
- **Authorized official:** BRUCE P THEALL MD (OWNER/MEDICAL DIRECTOR)
- **Authorized official phone:** (973) 673-3668

## Contact information

- **Practice address:** 310 CENTRAL AVENUE, SUITE 301, EAST ORANGE, NJ 07018-2835
- **Practice address phone:** (973) 673-3668
- **Practice address fax:** (862) 252-9542
- **Mailing address:** 310 CENTRAL AVENUE, SUITE 301, EAST ORANGE, NJ 07018-2835
- **Mailing address phone:** (973) 673-3668
- **Mailing address fax:** (862) 252-9542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NJ | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NJ | — |

## Other

- **Enumeration date:** 03/02/2011
- **Last updated:** 12/10/2013