| Doctor Name: | DR. MARYELLEN PATRICIA BRUCATO |
| NPI Number: | 1407148877 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | 25MD00315600 |
| Business Practice Address: | 550 Kinderkamack Rd Suite 202 Oradell, NJ - 076491500 |
| Business Phone Number: | 2012619445 |
| Business Fax Number: | |
| Mailing Address: | 103 Colfax Ave Fl 1, POMPTON LAKES |
| State: | NJ |
| Postal Code: | 074421736 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/04/2011 |
| NPI Last Update Date: | 03/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 25MD00315600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |