Individual
DR. JACK BRUDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
50 E 42ND ST RM 508, NEW YORK, NY 10017-5436
(212) 661-7003
(212) 661-7005
Mailing address
50 E 42ND ST RM 508, NEW YORK, NY 10017-5436
(212) 661-7003
(212) 661-7005
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
155544
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011594
GHI
—
05
—
01096693
—
NY
01
—
01156G
MEDICARE GHI
—
01
—
113945
AETNA
—
01
—
1900573
UNITED HEALTHCARE
—
01
—
52313
GHI MEDICARE CHOICE
—
01
—
NS1506
OXFORD HEALTH PLANS
—
Enumeration date
08/02/2006
Last updated
05/09/2022
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