Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 38MC00569500 | NJ |
N | 111NR0400X | Rehabilitation Chiropractor | 38MC00569500 | NJ |
NPI | 1558721209 |
---|---|
Provider Name | Dr. Terri Lynn Brucato |
First Address | Hamburg, NJ 07419-1328 |
Second Address | Randolph, NJ 07869-2142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2016 |
Last Update Date | 23/02/2016 |