NPIMap

Individual provider Active NPI

Bruno Marius Suditu, PA

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1427236835
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014453 Issued in NY
Practice address
6010 Bay Pkwy Ste 902
Brooklyn, NY 11204-6091
Phone
(718) 475-1700
Fax
(718) 475-1702
NPI assigned
Feb 7, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 014453 NY Primary
Physician Assistant 363A00000X 3520 CT

Addresses

Primary practice location

6010 Bay Pkwy Ste 902
Brooklyn, NY 11204-6091

Mailing address

24 Stevens St
Norwalk, CT 06850-3852
Phone (203) 852-2000

Other practice location 1

24 Stevens St
Norwalk, CT 06850-3852
Phone (203) 852-2000

Other identifiers 1

IdentifierTypeStateIssuer
03390269MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110720000118 NY Practitioner - Physician Assistant 9931279585 Reassigns benefits to 4 organizations
I20170629001134 CT Practitioner - Physician Assistant 9931279585 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Excel Urgent Care of Fishkill PLLCGroup PAC ID 9032267919, 11 clinicians
Westport Urgent Care LLCGroup PAC ID 4688826712, 7 clinicians
Orange Urgent Care PLLCGroup PAC ID 7113014820, 14 clinicians

Practice addresses (Care Compare)

1004 Main St
Fishkill, NY 12524-3509
Phone (845) 765-2240

1045 Post E Rd
Westport, CT 06880-5370
Phone (203) 557-8200

75 Crystal Run Rd
G40
Middletown, NY 10941-7013
Phone (845) 703-2273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
014453NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Parcare Community Health Network Inc CurrentSince Oct 17, 2019 Accepting new patients
Afc Physicians of Connecticut, PC CurrentSince Jun 10, 2024 Accepting new patients
Afc Physicians of Connecticut, PC CurrentSince Jun 10, 2024 Accepting new patients
Hudson Valley Emergency Medicine PLLC Past Accepting new patients
Eos Medical Group PC Past Accepting new patients
Fishkill Pharmacy LLC Past Accepting new patients
Norwalk Hospital Association Past Accepting new patients
Alabama Spine & Joint Center, P.C. Past Accepting new patients

Locations

2 Main St
Danbury, CT 06810
Phone (203) 826-2140

445 Park Ave
Brooklyn, NY 11205
Phone (718) 965-1320

6010 Bay Pkwy
Ste 901
Brooklyn, NY 11204
Phone (718) 238-2100

Interoperability endpoints

  • Direct secure messaging: exceloffishkill.brunosuditu@125001.advancedmd-direct.com
  • Direct secure messaging: orangeurgentcare.brunosuditu@123301.advancedmd-direct.com

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1427236835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 STEVENS ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503852",
            "telephone_number": "203-852-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6010 BAY PKWY STE 902",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112046091",
            "telephone_number": "718-475-1700",
            "fax_number": "718-475-1702"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Stevens St",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "068503852",
            "country_code": "US",
            "telephone_number": "203-852-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUDITU",
        "first_name": "BRUNO",
        "middle_name": "MARIUS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-07",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014453",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "3520",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03390269",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.