Active NPI
Bruce Gutelius
- Internal Medicine Physician
- Long Island City, NY
National Provider Identifier
1861934945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 248832-1
- Practice address
- 4209 28TH St
WS 06-01
Long Island City, NY 11101-4130 - Phone
- (347) 396-2617
- NPI assigned
- Nov 7, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 248832-1 | NY | Primary |
| Public Health & General Preventive Medicine Physician | 2083P0901X | MD167144 | OR |
Addresses
Primary practice location
4209 28TH St
WS 06-01
Long Island City, NY 11101-4130
Mailing address
4209 28TH St
WS 06-01
Long Island City, NY 11101-4130
Phone (347) 396-2617
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 248832-1 | NY | MD | Internal Medicine Physician |
| MD167144 | OR | MD | Public Health & General Preventive Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478476800000",
"number": "1861934945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4209 28TH ST",
"address_2": "WS 06-01",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111014130",
"telephone_number": "347-396-2617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4209 28TH ST",
"address_2": "WS 06-01",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111014130",
"telephone_number": "347-396-2617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTELIUS",
"first_name": "BRUCE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-11-07",
"last_updated": "2016-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "248832-1",
"primary": true
},
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "OR",
"license": "MD167144",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Island City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.