Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22DI01575800 | NJ |
NPI | 1154488526 |
---|---|
Provider Name | Dr. Bruce Walter Bitzer |
First Address | Glen Rock, NJ 07452-1543 |
Second Address | Glen Rock, NJ 07452-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |