Bruce Preston Theall, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

25MD00131000 Issued in NJ

Practice address

310 Central Ave
Suite 301
East Orange, NJ 07018-2835

Phone

(973) 673-3668

Fax

(862) 252-9542

NPI assigned

Oct 9, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Bruce Preston Theall Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1128816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231459200000",
    "number": "1831187434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 CENTRAL AVE",
            "address_2": "SUITE 301",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070182835",
            "telephone_number": "973-673-3668",
            "fax_number": "862-252-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 CENTRAL AVE",
            "address_2": "SUITE 301",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070182835",
            "telephone_number": "973-673-3668",
            "fax_number": "862-252-9542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEALL",
        "first_name": "BRUCE",
        "middle_name": "PRESTON",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-09",
        "last_updated": "2009-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00131000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC",
            "identifier": "4548860001",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRUCE",
            "last_name": "THEALL",
            "middle_name": "PRESTON",
            "prefix": "DR.",
            "credential": "DPM",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• The Bessie Mae Women's Health Center
• The Heart Center of the Oranges (The Heart Center of the Oranges- East Orange)
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• The Well Balanced Senior Program
• Marjorie Theodule Sr., DNP. APRN PMHNP B-C
• Therapeutic Vascular of New Jersey
• Theresa's Place Homecare Agency LLC (Theresa's Place #1 Homecare)
• Scott Randall Thien
• Alisha Thom-Hayes, PSYD

• Podiatrist in East Orange, NJ
• Providers in East Orange, NJ by specialty
• Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2009; 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.