Provider Demographics
NPI:1306031661
Name:BRUCEMFORESTERMD PC
Entity type:Organization
Organization Name:BRUCEMFORESTERMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-337-4444
Mailing Address - Street 1:55 NORTHWAY
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2325
Mailing Address - Country:US
Mailing Address - Phone:914-337-4444
Mailing Address - Fax:914-395-0831
Practice Address - Street 1:55 NORTHWAY
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2325
Practice Address - Country:US
Practice Address - Phone:914-337-4444
Practice Address - Fax:914-395-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097028102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty