Provider Demographics
NPI:1144504440
Name:BRUCK, ISAAC SAMUEL (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:SAMUEL
Last Name:BRUCK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1901 FIRST AVENUE
Mailing Address - Street 2:SUITE 2A31
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-423-6684
Mailing Address - Fax:212-423-6383
Practice Address - Street 1:1901 FIRST AVENUE
Practice Address - Street 2:SUITE 2A31
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-423-6684
Practice Address - Fax:212-423-6383
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275616207P00000X
CT52626207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine