1447269584 NPI number — LESLIE JEAN BRUSIE MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447269584 NPI number — LESLIE JEAN BRUSIE MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BRUSIE

Provider First Name:

LESLIE

Provider Middle Name:

JEAN

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1447269584

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

942 ROUTE 376

Provider Second Line Business Mailing Address:

SUITE 16

Provider Business Mailing Address City Name:

WAPPINGERS FALLS

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

12590

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

845-223-8080

Provider Business Mailing Address Fax Number:

845-223-8081

Provider First Line Business Practice Location Address:

942 ROUTE 376

Provider Second Line Business Practice Location Address:

SUITE 16

Provider Business Practice Location Address City Name:

WAPPINGERS FALLS

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

12590

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

845-223-8080

Provider Business Practice Location Address Fax Number:

845-223-8081

Provider Enumeration Date:

08/07/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  2028021 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 01775337 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 1976257 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
• Identifier: 2028021 . This is a "LICENSE" identifier . This identifiers is of the category "OTHER".
• Identifier: 33D0991911 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
• Identifier: 4C1525 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
• Identifier: 00V731 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 10031841 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
• Identifier: 53035 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: P2526879 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 141833509 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
• Identifier: 2191726 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 4C1525 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: 1783916003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 191724 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 5998555 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: O87164 . This is a "MVP" identifier . This identifiers is of the category "OTHER".