Individual
JUSTIN ADAM BRUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
777 PINE AVE, WEST ISLIP, NY 11795-2707
(631) 456-1779
Mailing address
777 PINE AVE, WEST ISLIP, NY 11795-2707
(631) 456-1779
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RTO000506
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/09/2018
Last updated
09/21/2021
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