Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 182228 | NY |
Y | 207PP0204X | Pediatric Emergency Physician | 25MA05404400 | NJ |
N | 208000000X | Pediatrician | 182228 | NY |
NPI | 1275621914 |
---|---|
Provider Name | Dr. Bruce Maurice Henry |
First Address | Bronx, NY 10463-6152 |
Second Address | Turnersville, NJ 08012-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 04/06/2020 |