Individual provider Active NPI

Nicole Josephine Bruzzese, RPA-C

  • Physician Assistant
  • Long Island City, NY
National Provider Identifier
1710296686
Registry record updated Sep 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014240 Issued in NY
Practice address
2510 30TH Ave
Long Island City, NY 11102-2448
Phone
(718) 267-4214
NPI assigned
Sep 27, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 014240 NY Primary

Addresses

Primary practice location

2510 30TH Ave
Long Island City, NY 11102-2448

Mailing address

189 Beach 130TH Street
Belle Harbor, NY 11694
Phone (718) 474-0011

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110104000225 NY Practitioner - Physician Assistant 9638367824 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014240NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Nov 4, 2019 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jun 1, 2024 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jun 1, 2024 Accepting new patients
New York University CurrentSince Nov 4, 2019 Accepting new patients

Locations

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

2715 30th Ave
Long Island City, NY 11102
Phone (718) 267-4808

170 William St
Fl 8
New York, NY 10038
Phone (212) 312-5000

150 E 42nd St
Fl 9
New York, NY 10017
Phone (646) 605-8119

10114 Liberty Ave
#13292
Ozone Park, NY 11417
Phone (718) 487-3330

Networks

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

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285545600000",
    "number": "1710296686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 BEACH 130TH STREET",
            "city": "BELLE HARBOR",
            "state": "NY",
            "postal_code": "11694",
            "telephone_number": "718-474-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 30TH AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111022448",
            "telephone_number": "718-267-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUZZESE",
        "first_name": "NICOLE",
        "middle_name": "JOSEPHINE",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-27",
        "last_updated": "2010-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

Verify at the official NPI Registry.