Provider Demographics
NPI:1740246099
Name:BRUCK, HAROLD M (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:M
Last Name:BRUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1543
Mailing Address - Country:US
Mailing Address - Phone:201-652-2800
Mailing Address - Fax:201-652-2963
Practice Address - Street 1:385 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1543
Practice Address - Country:US
Practice Address - Phone:201-652-2800
Practice Address - Fax:201-652-2963
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA019834002086X0206X
NY0908252086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY090825OtherSTATE MEDICAL LICENSE
NJ2809702Medicaid
NJMA01983400OtherSTATE MEDICAL LICENSE
NJ2809702Medicaid
NJBR178736Medicare ID - Type Unspecified