Individual
ADAM R BRUCCOLERI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-9158
(718) 226-6964
Mailing address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-9158
(718) 226-6964
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
014091
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03277983
—
NY
Enumeration date
07/26/2010
Last updated
12/01/2010
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