Provider Demographics
NPI:1699938258
Name:BRUCE L. EDWARDS MD P L L C
Entity type:Organization
Organization Name:BRUCE L. EDWARDS MD P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-933-1125
Mailing Address - Street 1:700 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4932
Mailing Address - Country:US
Mailing Address - Phone:516-933-1125
Mailing Address - Fax:516-822-8424
Practice Address - Street 1:700 OLD COUNTRY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4932
Practice Address - Country:US
Practice Address - Phone:516-933-1125
Practice Address - Fax:516-822-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD91825Medicare UPIN