Individual
DR. BRUCE PRESTON THEALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
310 CENTRAL AVE, SUITE 301, EAST ORANGE, NJ 07018-2835
(973) 673-3668
(862) 252-9542
Mailing address
310 CENTRAL AVE, SUITE 301, EAST ORANGE, NJ 07018-2835
(973) 673-3668
(862) 252-9542
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00131000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4548860001
MEDICARE NSC
NJ
Enumeration date
10/09/2005
Last updated
01/09/2009
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