Luzato Medical Group P.C.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

LUZATO MEDICAL GROUP P.C.

Practice address

1812 College Point Blvd
College Point, NY 11356-2221

Phone

(718) 461-9105

Fax

(716) 461-3392

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jack Bruder, M.D.

Title

President

Phone

(718) 461-9105

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• College Point Medical Group Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Luzato Medical Group, P.C.

  • Urology Physician
  • New York, NY
  • NPI 1649429382

  O20090224000459

  Same enrollment

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Allen B Chefitz, MD

  • Surgery Physician
  • New Rochelle, NY
  • NPI 1619077856
  NPD (past)
• Suhasini Jonnavithula, MD

  • Internal Medicine Physician
  • College Point, NY
  • NPI 1790966265
  NPD (past)
• Moosa Nejat, M.D.

  • Specialist
  • Great Neck, NY
  • NPI 1972519965
  NPD (past)
• David Resnick

  • Allergy Physician
  • West Nyack, NY
  • NPI 1922064435
  NPD (past)
• Dillian La Salle, M.D.

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1659307569
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1164576385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 COLLEGE POINT BLVD",
            "city": "COLLEGE POINT",
            "state": "NY",
            "postal_code": "113562221",
            "telephone_number": "718-461-9105",
            "fax_number": "716-461-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 COLLEGE POINT BLVD",
            "city": "COLLEGE POINT",
            "state": "NY",
            "postal_code": "113562221",
            "telephone_number": "718-461-9105",
            "fax_number": "716-461-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUZATO MEDICAL GROUP P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BRUDER",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-461-9105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "5501024",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College Point Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Telen Sioe Tjeng Lim, PHARMACIST
• Jenny Yuan-Lin Liu, PHARM D
• Frank James Loccisano, M.D.
• Kristen Renae Lombardo
• Luxottica of America Inc.
• Yuqing Ma
• Thomas Magaldi, LMHC, RPH.
• Roxana Maldonado, REGISTERED NURSE
• Ruby R Malva, MD
• Matteo Chiropractic & Physical Therapy PLLC

• Gastroenterology Physician in College Point, NY
• Providers in College Point, 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 Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.