Provider Demographics
NPI:1316243777
Name:BRUDER MD HAIR PC
Entity type:Organization
Organization Name:BRUDER MD HAIR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-288-2887
Mailing Address - Street 1:122 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7358
Mailing Address - Country:US
Mailing Address - Phone:212-288-2887
Mailing Address - Fax:212-308-7094
Practice Address - Street 1:122 E 64TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7358
Practice Address - Country:US
Practice Address - Phone:212-288-2887
Practice Address - Fax:212-308-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty