Theall, Bruce Preston
Theall, Bruce Preston is an sole proprietor health care provider with primary practice located at 310 Central Ave Suite 301, East Orange NJ 07018-2835. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Theall, Bruce Preston can be contacted via phone (973) 673-3668.Contact Information
Primary practice address
310 Central Ave Suite 301
East Orange NJ 07018-2835
Phone: (973) 673-3668
Fax: (862) 252-9542
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 25MD00131000 | New Jersey |
Profile Details
| NPI number | 1831187434 |
|---|---|
| LBN Legal business name | Theall, Bruce Preston |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 9th, 2005 |
| Last updated | Jan 9th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831187434 | NPPES |
| New Jersey | Other | 4548860001 | MEDICARE NSC |
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