Bruce Phariss, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA08185900 Issued in NJ

Practice address

8 Hillside Ave
Suite 106
Montclair, NJ 07042-2129

Phone

(973) 509-2371

Fax

(973) 744-9003

NPI assigned

Oct 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 25, 2016 through Jan 25, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417996800000",
    "number": "1255428322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 HILLSIDE AVE",
            "address_2": "SUITE 106",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422129",
            "telephone_number": "973-509-2371",
            "fax_number": "973-744-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 HILLSIDE AVE",
            "address_2": "SUITE 106",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422129",
            "telephone_number": "973-509-2371",
            "fax_number": "973-744-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHARISS",
        "first_name": "BRUCE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-09",
        "last_updated": "2014-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NY",
            "license": "188784",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA08185900",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "188784",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NJ",
            "license": "25MA08185900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aniella Lincoln Perold, PHD
• Brianna Peterson
• Edward Petrarca, LCSW
• Kristen Ernst Petterson, RD
• Andrea Peyser, LCSW
• Physical Medicine and Rehabilitation Associates LLC
• Kevin Picardo, DPT
• Christina Pierre-Noel, MSW, LCSW
• Jonas Pierre
• Pilates Advantage Physical Therapy

• All providers in Montclair, NJ
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.