Most Relevant Information
Provider Data
| NPI Number: | 1003359266 |
| Provider Name: | BRUCE W MARTIN FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 341243 |
Most Important Dates
| Enumeration Date: | 11/21/2016 |
| Last Updated: | 11/21/2016 |
Provider Practice Location
101 SAINT ANDREWS LN
GLEN COVE
NY
115422254
Practice Location Phone/Fax
| Phone: | 5166747461 |
| Fax: |
Provider Mailing Location
101 SAINT ANDREWS LN
GLEN COVE
NY
115422254
Provider Mailing Phone/Fax
| Phone: | 5166747461 |
| Fax: |