Bruce D Marzullo, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

037383 Issued in NY

Practice address

43 Lagrange Avenue
Poughkeepsie, NY 12603

Phone

(845) 452-2900

Fax

(845) 452-4974

NPI assigned

Feb 7, 2007

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeast Implant & Oral Surgery, PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Danbury, CT
  • NPI 1215152574
  NPD (past)

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1154461689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 LAGRANGE AVENUE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "12603",
            "telephone_number": "845-452-2900",
            "fax_number": "845-452-4974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 LAGRANGE AVENUE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "12603",
            "telephone_number": "845-452-2900",
            "fax_number": "845-452-4974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARZULLO",
        "first_name": "BRUCE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "037383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01017770",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Rose Martinson, COTA
• Ellen J. Marx, PH.D.
• James Louis Marxer, NBC/HIS
• Mary Dyer MD PLLC
• Mary Mantilla LCSW, PLLC
• John Mascia, MD
• Joan Masotti
• Marcia Masri
• Kristina Marie Massari, RN
• Toni-Ann Mastando

• Oral and Maxillofacial Surgery (Dentist) in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.