Provider Demographics
NPI:1053933861
Name:BRUZGA, ELISSA
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:BRUZGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SCHOENFELD BLVD
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2961
Mailing Address - Country:US
Mailing Address - Phone:631-433-8354
Mailing Address - Fax:
Practice Address - Street 1:208 SCHOENFELD BLVD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2961
Practice Address - Country:US
Practice Address - Phone:631-433-8354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY702133163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical