Provider Demographics
NPI:1194867242
Name:BRUCK, ERICA (LAC)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:BRUCK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SHORE RD
Mailing Address - Street 2:STE. 5N
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5337
Mailing Address - Country:US
Mailing Address - Phone:516-315-8189
Mailing Address - Fax:
Practice Address - Street 1:265 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3625
Practice Address - Country:US
Practice Address - Phone:718-327-4970
Practice Address - Fax:718-471-6542
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist