Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 133757 | NY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 133757 | NY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD017256E | PA |
NPI | 1134173669 |
---|---|
Provider Name | Dr. Bruce Alan Ellsweig |
First Address | Middletown, NY 10941-4028 |
Second Address | Rock Hill, NY 12775-6049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 12/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03778338 | (05) | NY |