Organization
BRUCE THEALL DPM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE P THEALL MD (OWNER/MEDICAL DIRECTOR)
(973) 673-3668
Entity
Organization
Contact information
Practice address
310 CENTRAL AVENUE, SUITE 301, EAST ORANGE, NJ 07018-2835
(973) 673-3668
(862) 252-9542
Mailing address
310 CENTRAL AVENUE, SUITE 301, EAST ORANGE, NJ 07018-2835
(973) 673-3668
(862) 252-9542
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
NJ
332B00000X
Durable Medical Equipment & Medical Supplies
—
NJ
Other
Enumeration date
03/02/2011
Last updated
12/10/2013
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