Provider Demographics
NPI:1861420077
Name:ROSE, BRUCE T (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:T
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:811 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1530
Mailing Address - Country:US
Mailing Address - Phone:609-303-4600
Mailing Address - Fax:609-303-4601
Practice Address - Street 1:811 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1530
Practice Address - Country:US
Practice Address - Phone:606-303-4600
Practice Address - Fax:609-303-4601
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08162800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5841909Medicaid
NJ107110AP0Medicare PIN
NJH23251Medicare UPIN