Alex Harry Bruckstein, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

NY129764 Issued in NY

Practice address

2627 Hylan Blvd
Staten Island, NY 10306-4339

Phone

(718) 667-3200

Fax

(718) 667-6615

NPI assigned

May 19, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273017600000",
    "number": "1114971835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064339",
            "telephone_number": "718-667-3200",
            "fax_number": "718-667-6615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064339",
            "telephone_number": "718-667-3200",
            "fax_number": "718-667-6615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKSTEIN",
        "first_name": "ALEX",
        "middle_name": "HARRY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2010-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "NY129764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "325101",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Browning, RN
• Christie Brownlee, LMSW
• Adam R Bruccoleri, P.A.
• Dana Anne Bruce
• Merril Eve Bruce
• Scott Albert Bruggemann, MS, CF-SLP
• Amanda Marie Bruhm, M.D.
• Laura Ann Bruij, STUDENT
• Seth U Brum, M.D.
• Shoshana Brum

• Gastroenterology Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Gastroenterology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.