Individual
BRUNO MARIUS SUDITU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6010 BAY PKWY STE 902, BROOKLYN, NY 11204-6091
(718) 475-1700
(718) 475-1702
Mailing address
24 STEVENS ST, NORWALK, CT 06850-3852
(203) 852-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
014453
NY
363A00000X
Physician Assistant
3520
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03390269
—
NY
Enumeration date
02/07/2008
Last updated
10/17/2019
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